^ 

>^^< 


IMAGE  EVALUATION 
TEST  TARGET  (MT-3) 


1.0 


I.I 


l^|2^    12.5 

Urn  ^^*     m^M 


14.0 


IL25  lllu 


1^ 


1.6 


1 


Pl£)togpaphic 
^Sdaices 
Corporation 


^> 


23  WIST  MAIN  STRUT 

WiBSTiR,N.Y.  I4SM 

(71«)R72-4S03 


CIHM/ICMH 

Microfiche 

Series. 


CIHM/ICIVIH 
Collection  de 
microfiches. 


Canadian  Instituta  for  Historical  IMicroraproductions  /  Institut  Canadian  da  microraproductions  historiquas 


Technical  and  Bibliographic  Notat/Notat  tachniquaa  at  bibliographiqua* 


Tha  Instituta  ha*  attamptad  to  obtain  tha  baat 
original  copy  availabia  for  filming.  Faatura«  of  thia 
copy  which  may  Im  bibliographically  uniqua. 
which  may  altar  any  of  tha  imagas  in  tha 
reproduction,  or  which  may  significantly  change 
the  usual  method  of  filming,  are  checked  below. 


Q 


Coloured  covers/ 
Couverture  de  couleur 


I      I   Covers  damaged/ 


n 


D 
D 
D 
D 

D 


Couverture  endommagte 

Covers  restored  and/or  laminated/ 
Couverture  restaur^  et/ou  pelliculiie 


I      I   Cover  title  missing/ 


Le  titre  de  couverture  manque 


n~j   Coloured  maps/ 


D 


Cartes  giographiques  en  couleur 

Coloured  inic  (I.e.  other  than  blue  or  black)/ 
Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 


Coloured  plates  and/or  illustrations/ 
Planches  et/ou  illustrations  en  couleur 


Bound  with  other  material/ 
ReliA  avac  d'autres  documents 

Tight  binding  may  <.ause  shadows  or  distortion 
along  interior  margin/ 

La  re  Mure  :ierr6e  peut  causer  de  I'ombrft  ou  de  la 
distortion  le  long  de  ia  marge  intArieure 

Blank  leaves  added  during  restoration  may 
appear  within  the  text.  Whenever  possible,  these 
have  been  omitted  from  filming/ 
II  se  peut  que  certainas  pages  blanches  ajouties 
lors  d'une  restauration  apparaissant  dans  le  texte, 
mais,  lorsque  cela  Atait  possible,  ces  pages  n'ont 
pas  6x6  film6es. 

Additional  comments:/ 
Commentaires  supplAmentaires: 


L'Institut  a  microfilm*  le  meilleur  exemplaire 
qu'ii  lui  a  6X6  possible  de  se  procurer.  Les  details 
da  cat  exemplaire  qui  sont  peut-Atre  uniques  du 
point  de  vue  bibliographique,  qui  peuvent  modifier 
une  image  reproduite,  ou  qui  peuvent  exiger  une 
modification  dans  la  mithoda  nof  r.  :)le  de  filmage 
sont  indiquAs  ci-dessous. 


I      I   Coloured  pages/ 


D 


Pages  de  couleur 

Pages  damaged/ 
Pages  endommag4es 

Pages  restored  and/oi 

Pages  restaurias  et/ou  pellicultes 

Pages  discoloured,  stained  or  foxet 
Pages  dicolories,  tachaties  ou  piqutes 

Pages  detached/ 
Pages  dAtachies 

Showthrough/ 
Transparence 

Quality  of  prir 

Quality  inigale  de  {'impression 

Includes  supplementary  materii 
Comprend  du  materiel  supplAmentaire 

Only  edition  available/ 
Seule  Mition  disponible 


I — I  Pages  damaged/ 

r~^  Pages  restored  and/or  laminated/ 

r~^  Pages  discoloured,  stained  or  foxed/ 

I      I  Pages  detached/ 

pTT-  Shovt/through/ 

I      I  Quality  of  print  varies/ 

r~|  Includes  supplementary  material/ 

I     I  Only  edition  available/ 


Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc.,  have  been  refilmed  to 
ensure  the  best  possible  image/ 
Les  pages  totalement  ou  partiellement 
obscurcies  par  un  feuillet  d'errata,  une  pelure. 
etc.,  ont  M  filmies  A  nouveau  de  faqon  it 
obtenir  la  meilleure  image  possible. 


JW,i  item  is  filmed  at  the  reduction  ratio  checked  below/ 

Ce  document  est  film*  au  taux  de  r4duction  indiquA  ci-da*sous. 

10X  14X  ItX  22X 


2ftX 


aox 


/ 


12X 


16X 


aox 


MX 


28X 


32X 


Th«  copy  fllni«d  tMr*  hM  b««n  r«produe«d  thanks 
to  tho  gonorothy  of: 

Librnry  of  tho  Public 
Archives  of  Canada 


L'axamplaira  fllmA  fut  raproduit  grAca  A  la 
gAnArosit*  dc: 

La  bibiiothAqua  daa  Archivaa 
pubiiquas  du  Canada 


Tha  imagas  appearing  hara  ara  tha  bast  quality 
possible  Ronsldering  the  condition  and  legibility 
of  the  original  copy  and  in  keeping  with  the 
filming  contract  specifications. 


Original  cooles  In  printed  paper  covers  are  filmed 
beginning  v  ith  the  front  covei  and  ending  on 
the  last  pace  with  a  printed  or  Illustrated  impres- 
sion, or  the  back  cover  when  appropriate.  All 
other  original  coplee  are  filmed  beginning  on  the 
first  page  wKh  a  printed  or  illustrated  Impree- 
sion,  and  ending  on  the  last  page  with  a  printed 
or  illustrated  impression. 


Les  imoge.  -luiventes  ont  AtA  ^eproduites  avac  le 
plus  grand  soin,  compta  tenu  de  la  condition  at 
da  la  nettet*  de  I'exemplaire  film*,  et  en 
conformity  avac  les  conditions  du  contret  de 
filmege. 

Les  exemplalres  originaux  dont  la  couverture  en 
papier  eat  ImprimAa  sent  filmto  en  commen^ent 
per  le  premier  plat  et  en  terminant  salt  par  la 
darnlAre  page  qui  comporte  une  empreinte 
d'impression  ou  d'lllustratlon,  soit  par  le  second 
plat,  salon  le  cas.  Tous  les  autres  exemplaires 
originaux  sent  filmte  en  commenpant  par  la 
premlAre  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration  et  en  terminant  par 
la  darnlAre  page  qui  comporte  une  telle 
empreinte. 


The  last  recorded  frame  on  each  microfiche 
shell  contain  the  symbol  — »•  (meaning  "CON- 
TINUED"), or  th««  symbol  V  (meaning  "END"), 
whichever  applies. 


Un  dss  symboles  suivants  apparaftra  sur  ia 
darnlAre  Image  de  cheque  microfiche,  selon  le 
ces:  le  symbols  — »» signifie  "A  SUiVRE",  le 
symbols  V  signifie  "FIN". 


Maps,  plates,  charts,  etc.,  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  are  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  Illustrate  the 
method: 


Les  cartas,  plar^ches,  tableaux,  etc.,  peuvent  Atre 
fllmAs  A  des  taux  de  rAduction  diff Arents. 
Lorsque  le  document  est  trop  grand  pour  Atre 
reprodult  en  un  seui  cllchA,  II  est  f  llmA  A  partir 
de  I'angia  supArleur  gauche,  de  gauche  A  droHe, 
et  de  haut  en  has,  en  prenent  le  nombre 
d'Imagas  nAcessaire.  Las  diagrammes  suivants 
illustrant  la  mAthode. 


1  2  3 


1 

2 

3 

4 

5 

6 

J*^' 


<4>i^A 


~».,«J.A.-»»v«rt 


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I  TS 


CAUSES,     SYMPTOMS. 


AND 


.         ) 


TREATMENT, 

(K)NSIDERED  AND   EXPLAINED, 

■      BY  J.  P.  BATCH1'.LDER,  M.D., 

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,  _         ;.  ,.;  ..  ..  .      ..  ,  ..  ., 


>  n  i ;  ■'  I 


CHOLERA,  &c. 


(•  t 


4 


Thc  fact  that  through  certain  phenomena  presented  with  tolera- 
ble uniformity  by  epidemics,  there  runs  an  analogy  which,  taken  in 
connexion  with  circumstances  attending  their  movements,  progress, 
and  termination,  has  led  to  the  thought  that  their  causes,  although 
involved  in  irapenttrable  obscurity,  may  be  few— similar — perhaps 
identical ;  while  the  effects  they  produced  were  modified  by  acci- 
'4'dents,  incident  to  their  evolution,  by  circumstances  pertaining  to 
the  subjects  acted  on;  or  by  contingencies  connected  with  season, 
climate.  Sec.  This  view,  it  must  be  admitted,  accords  well  with 
the  simplicity  of  Nature,  who  produces  the  greatest  number  and 
variety  of  effects  from  the  feweat  possible  causes,  in  which  her  wis- 
dom is  apparent,  and  manifestly  difleri}nt  from  that  of  man,  who  is 
prone  to  overlook  the  simple  means  by  which  her  vast  machinery 
is  put  and  kept  in  motion  for  the  attainment  of  results  the  most 
grand  and  sublimo.  Ignorant  of  causes,  we  may,  however,  by 
watching  the  phenomena  they  originate,  deduce  the  laws  by  which 
they  are  governed :  and  furthermore,  by  reasoning  from  effects,  we 
are  sometimes  led  to  a  knowledge  of  their  causes. 

By  pursuing  this  method  in  respect  to  chemical  affinity,  gravita- 
tion, etc.,  philosophers  have  been  able  to  deduce  and  settle  their 
laws  so  firmly  that  we  implicitly  and  unconsciously  act  on  them  in 
our  daily  pursuits;  and  by  patient  observance,  careful  analogy,  and 
study  of  the  phenomena  of  diseases,  we  have  likewisa  become 
acquainted  with  the  laws  by  vvhich  they  are  governed  without 
knowing  their  causss.  Tn  respect  to  Cholera  this  method  has  been 
unfortunately  too  much  neglected, and  the  attention  has  been  diverted 
from  its  legitimate  objects;  hence  the  failure  to  ascertain  and  settle 
in  a  satisfactory  manner,  the  laws  by  which  its  propagation  from  in- 
dividual to  iadividual  is  regulated  and  determined,  and  also  its  pre- 
cise nature. 


Q 
J 


/ 


4  CHOLERA,    CONSIDERED   AND    EXPLAINED. 

Having  considered  this  part  of  the  subject  so  far  as  it  relates  to 
conta^i'^n  and  infection,  in  another  pa|)rr,  we  now  proceed  to  in- 
quire into  the  nature  and  symptoms  of  Cholera,  and  the  causes  hy 
which  they  are  induced,  and  the  laws  by  which  they  are  governed, 
and  endeavor  to  ascertain  whether  they  justify  the  conclusion  that 
it  is  a  disease  sui  generis. 

Disease  has  been  defined,  "  A  derangement  of  the  function  or 
structure  of  an  organ."* 

The  performance  of  function  depends  on  the  normal  action  of  the 
capillaries  of  the  respective  organs,  modified  by  peculiarity  of 
structure. 

If  the  due  performance  of  function  depends  on  the  healthy 
action  of  the  capillaries,  by  a  parity  of  reasoning,  a  derangement 
of  function,  which  constitutes  disease,  must  depend  on  the  de* 
ranged  action  of  those  vessels.  Now,  the  action  of  an  organ  as  a  ^ 
whole,  which  is  its  function,  and  that  of  all  its  capillaries,  is  iden- 
tical, and  constitutes  the  function  ;  and  e  eonvtrao  what  an  organ  as 
a  whole  does,  that  will  all  its  capillaries  do — they,  then,  it  may  be 
said,  perform  its  function. 

"  The  noiseless  and  printless  feet  of  time"  move  not  less  stilly 
and  imperceptibly  in  their  rounds,  than  di)  the  various  organs  in 
the  body,  in  the  healthy  performance  of  their  respective  functions ; 
therefore,  in  health,  rvery  function  is  performed  in  such  a  manner 
that  the  individual  has  no  kr.owledge  of  it,  or  of  the  organ  which 
performs  it. 

When  the  capillaries  of  an  organ,  and  the  fluids  they  contain,  are 
normil,  the  sole  causi  which   prompts  the  former  to  action,  is  the 
mere  simple  mechanical  distension  occasioned  by  the  latter;  but  if 
that  st.ite  cither  of  the  fluids  or  the  cioillary  vessels  is  disturbed, 
derangement  of  function  ensues. 

From  the  altered  condition  of  one  or  other  of  these  (the  fluids  or 
the  capillaries)  disease  arises,  and  the  human  body  is  so  constituted, 
that  change  of  action  from  the  normal  to  the  abnormal,  if  con- 
siderable, is  perceived,  and  the  perception  of  that  change  con- 
stitutes feeling;    hence   pains,  aches,   and  disagreeable  feelings, 

*  Dcrnngement  or  structure  Is  soeondary— if  tlie  rosnlt  of  disturbed  fonction. 
If  primary,  it  is  the  consequenea  of  violence.  In  neitlier  of  these  respects  will 
it  come  wittiin  tlie  scope  of  ttiis  inquiry. 


.'/- 


.    Il 


to 

in- 

J»'y 

|ed, 
lat 

or 


CHOLERA,   CONSIDEKBD  AND   EXPLAINED.  5 

which  comprise  a  large  and  very  important  class  of  symptoms. 
The  inference  drawn  from  these  premises  is,  that  if  the  action  of 
an  organ  is  pei'ceived  it  is  a  sign  of  disease. 

If  the  sensibility  of  vessels  is  changed  or  altered,  morbid  action 
ensues,  although  the  fluids  should  remain  the  same.  On  the  other 
hand,  if  the  fluids  are  contaminated,  or  altered  in  their  physical 
or  chemical  properties,  morbid  action  as  certainly  ensues.  How  ? 
Changed  in  either  of  these  particulars,  the  fluids  make  a  novel, 
strange,  and  consequently  disagreeable  impression  on  the  inner 
surface  of  (he  capillaries,  which  stimulates  them  to  contract — 
the  only  real  action  of  which  they  are  capable ;  hence  the  rigor 
which  ushers  in  malarious,  infectious,  and  most  endemic  diseases, 
and  also  cholera  proper,  particularly  in  its  cold  stage;  but  in  the 
former,  as  for  example  intermittent  fever,  small-pox,  and  measles, 
this  contraction  of  the  capillaries  is  general,  and  is  soon  succeeded 
or  followed  by  a  spontaneous  relaxation.  Hence  the  febrile  excite- 
ment which  ensues,  and  likewise  the  various  kinds  of  inflammation 
that  follow  in  train.  In  these  last,  small-pox,  &c.,  the  contraction 
is  only  general,  and  is  followed  by  a  spontaneous  relaxation ;  but  let 
us  remark,  and  remember  too,  that  in  Cholera  the  contraction  of  the 
capillaries  ia  universal,  and  not  as  in  the  other  diseases  usually 
followed  by  the  spontaneous  relaxation  of  which  we  have  spoken — 
the  non  inoentua  of  which,  taken  in  connexion  with  the  univer- 
sality of  the  contraction,  famishes  a' mark  of  distinction  between  it 
(Cholera)  and  them.*  When  induced,  as  it  sometimes  is,  almost 
exclusively  by  the  concentrated  energy  of  its  own  peculiar  or  spe- 
cific cause  (if  such  a  cause  it  ha.<t),  the  contraction  of  the  capillaries 
is  so  vehement  as  to  stop  at  once  or  arrest  speedily  every  organic 
action,  and  either  cause  death  instantly,  or  in  a  very  short  time. 
Or  if  the  contraction  be  not  so  vehement,  it  may  be  so  persistent  as 
to  interrupt  functions  essential  to  life,  and  destroy  the  patient,  not 
so  soon,  but  as  certainly.  Results  analogous  to  these  are  sometimes 
occasioned  by  the  causes,  when  highly  concentrated,  of  malignant 
or  malarious  diseases,  in  which,  as  in  Cholera,  the  spontaneous 
relaxation  of  the  capillaries  never  takes  place,  consequently  the 
patient  soon  dies.     In  numerous  instances  in  Cholera,  and  likewise 

*  In  some  cases,  this  relaxation  and  sutiseqaant  excitement  do  succeed  to  an 
,  attack  of  Cholera,  as  noticed  hereafter. 


/ 


e 


CHOLEBA,    CONSIOBHED    ANU   EXPLAINED. 


I 


in  maliirious,  and  even  infectious  diseases,  prcdisposinp;  causcu 
may  act  iMiwcTfiilly  and  give  a  Htron^  predisposition,  and  yet  the 
disease  not  b(<  indiin^d,  unless  an  excitinjf  cause,  as  a  debauch, 
exposure  to  cold,  or  inn\>t,  is  superadded.  Again — those  predispos- 
ing cuuses  may  be  so  accumulated  or  concentrated,  as  to  become 
in  thoHiSi'lves  exciting  causes,  by  which  their  respective  diseases 
are  produced,  with  little  aid  t'rum  any  other  agent  as  an  exciting 
caufe  : — or  indeed  the  common  exciting  may  become  the  predispos- 
ing causes  whicli  give  the  system  so  strong  a  proclivity  to  the  dis- 
ease in  question  (Chol^fB),  as  well  as  others,  that  it  will  be  induced 
by  even  a  very  triflidfjafiplicationof  its  own  peculiar  cause.  When 
attacks  of  Cholera  are  brought  on  in  cither  of  these  ways,  a  more 
favorable  result  may  be  anticipated,  than  when  chiefly  induced  by 
the  concentrated  energy  qf  its  specific  cause.  The  reason  for  this 
has  already  been  assigned.  These,  with  many  other  considerations, 
go  far  to  show  that  Cholera  is  very  like  other  endemic  diseases, 
which  have  never  been  suspected  of  being  infectious  or  contagious. 

Like  most  other  diseases.  Cholera  has  its  predisposing  and  excit- 
ing causes ; — a  proximate  and  also  perhaps  a  specific  cause,  and  is 
probably  a  disease  aui  generis. 

The  predisposing  causes  produce  a  state  of  body  which  gives  it 
a  proclivity  to  a  disease,  which  is  technically  termed  the  pre-disposi- 
tion.  As  we  progress  we  shall  endeavor  to  show  what  is  the  pre- 
cise condition  of  the  system  whrch  constitutes  the  predisposition  to 
Cholera. 

The  predisposing  causes  are  of  two  kinds,  the  common  and  the 
specific.        ^    »     /  «    .;  ._•....        .., 


I.  THE  COMMON  PREDISPOSING  CAUSES 


urn)-. 


Tend  to  produce  other  ailments  as  well  as  Cholera,  and  in  all 
cases  act  in  the  same  manner. 

All  the  causes  belonging  to  this  class  are  indigenous,  and  under 
certain  circumstances  to  which  we  shall  allude  become  exciting 
causes.  Poverty  with  all  its  attendant  ills,  privation,  starvation, 
bad  food,  bad  air,  bad  lodging  and  clothing,  previous  sickaess, 
affections  of  the  mind,  intemperance,  fatigue,  exposure  to  cold, 
night  air,  &c. 


■-■*.'.v*".i.*  WV>»i 


vij.   «!"  ^S«fl«.'H./  , 


St 


CHOLERA,   CONSIDERED   AND  EXPLAINED. 


sen 
he 
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08- 

me 
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nore 


That  these  cauMs  ar«  all  indigenous  and  invariably  present  in 
every  place  where  Cholera  has  pieviiilod  ;  that  its  prevalence  has 
been  commensurate  witli  their  existence,  und  that  it  ha.4  ncvt-r  pre- 
vailed to  any  extent,  ilat  all,  in  the  absence  of  these  causes, — are 
facts  of  the  highest  concernment  and  furnish  matter  for  profound 
consideration,  not  to  medical  men  only,  l>ut  to  all,  ^nCi  particularly  to 
our  city  authorities,  who  are  principally  responsible  for  the  exist- 
ence of  some  of  those  causes,,  and  moreover  for  the  consequ.-nces  that 
will  inevitably  accrue  from  the  neglect  to  have  them  removed  should 
the  Cliolera  prevail  in  (his  metropolis.  Impressed  by  the  import- 
ance uf  this  subject,  we  shall  examine,  aeriatim,  but  briefly,  these 
causos;  and  explain  the  manner  in  which  they  act  in  predisposing 
to  Cholera,  and  in  co-operating  with  the  specific  cause  in  the  pro- 
duction of  that  disease. 

■  We  start  with  the  broad  comprehensive  proposition,  that  they 
all  produce  one  common  effect — a  general  contraction  of  the  capil- 
laries over  the  body,  which  constitittca  the  predisposition. 

The  paleness,  if  the  capillary  contraction  is  6nly  of  short  continu- 
ance;— the  emaciation,  diminution  in  size,  weight,  &c.,  if  more  per- 
sistent, are  proofs  sustaining  this  allegation.  In  the  production  of 
that  effect,  each  cause  operates  in  its  own  peculiar  way  ;  therefore 
we  shall  consider  them  singly  and  in  succession. 

1.  Deficiency  of  food  ;  or  htmger,  and  its  effects. 

When  food  is  being  taken  into  the  stomach,  the  pleasant 
impireasion  which  it  makes  on  thft  pabte  fanses  tha  capil-' 
laries  and  their  pores  to  relax,  and  allow  the  fluids  to  pass  into  the 
fauces,  &c.,  and  when  it  is  received  into  the  cavity  of  the  organ, 
it  makes  a  pleasant  sensation  there  which  causes  its  capillaries  to 
relax,  and  the  organ  doing:  as  a.  whole  what  all  its  vessels  do,  re- 
laxes, and  continues  to  do  ao  until  its  muscular  coat  is  put  on  the 
stretch  by  the  mechanical  distension  of  the  food,  and  the  sense  of 
repletion  is  experienced — an  intimation  that  enough  has  been  eaten. 
The  pores  looking  into  the  cavity  of  the  stomach  also  relax,  and 
the  gastric  juice  is  secreted.  Digestion  begins,  and  as  it  progresses 
the  Btomach  contracts  and  forces  its  contents  through  the  pylorus 
until  it  is  completely  emptied.  It  may  now  relax  spontaneously, 
which  prevents  the  s^nae  of  lounger  from  being  perceived ;  but 


/? 


y  .^  ^»  a  r^  I 


8 


CHOLERA,   CONSIDEHXD  AMD  BXPLAINEO. 


I 


u 


this  relaxation  will  be  followed  by  an  increased  admission  of  blood 
into  its  capillaries,  and  especially  into  those  belonging  to  the  tnus« 
cular  coat,  and  the  organ  now  again  contracts  painfully*  and  g'iY»:. 
rise  to  the  sensation  of  hunger.  ''f>:^ 

If  now,  food  or  anything  which  makes  a  pleasing  impression  on 
the  inner  surface  of  the  stomach,  or  a  pill  of  opium,  whose  narcotic 
influence  blunts  the  sensibility  of  the  part,  which  is  equivalent  to 
a  pleasing  impression,  the  organ  as  a  whole  relaxes,  and  the  sensa- 
tion of  hunger  goes  off.  If  nothing  be  taken,  and  the  meal  time  is 
passed,  the  stomach  relaxes  spontaneously,  and  hunger  ceases  to  be 
experienced  until  the  approach  of  the  period  for  taking  the  next 
meal,  when  the  stomach  contracting  gives  rise  to  the  same  painful* 
sensation.  Now,  the  receptioii  of  food  is  what  is  intended  by 
nature  to  cause  this  change  by  which  hunger  is  removed,  and. 
which  we  have  no  doubt  contists  in  a  relaxation  of  the  vessels 
and  of  the  stomach  as  a  whole.  If  this  physical  agent  is  withheld, 
the  capillaries  of  the  stcoiAch  will  become  more  and  more  con- 
tracted, until  the  patient  experiences  a  sort  of  feeling  as  if  tfie 
stomach  and  bowels  were  fastened  to  the  back-bone,     ^^■^^ii.,^i:p^jsi 

The  food  withheld,  tiie  capillaries  ^ver  the  whole  body  doings 
sympathetically  what  those  of  the  stomach  and  bowels  do,  that  ia, ' 
contract,  hence  the  pallor  which  is  always,  sooner  or  later,  the 
concomitant  of  hunger.     Again,  chyme  and  chyle  are  not  formed, 
and  consequently  not  absorbed-~the  vessels  of   the  viscera  are 
destitute  of  what  should  distend  them  and  become  permanently 
constricted — hence  the  emaciation.     When  this  state  of  the  ^rstem,  •  ' 
which  constitutes  a  strong  predisposition,  exists,  the  slightest 
possible  application  of  the  specific  cause  will  be  sufficient  to  bring 
on  the  disease.    Or  if    the  Choleraic  agent  exerts  only  a  vetf' 
moderate  influence  in  conjnnetion  with  the  predisposition  induced' 
by  the  predisposing  cause  under  consideration  (deficiency  of  food), 
the  addition  of  any  of  the  commonly  exciting  causes  will.iosure  ait- 
attack.*     3>8trt  %ir<ifi»jt*r;i*ij!!'  .    f-  r  fWHjBjqoi 


*  PbllosophiesUy  considered,  hjw  I*  haager  relievad  by  uktagfoodl    The, 
pleasant  Impression  of  fiKxl  upon  tlie  palate  induces  tbe  vessels  of  that  part^ 
and  of  the  salivary  glands  to  relax  and  admit  more  blood,  and  inore  saliva  is 
secreted,  because  all  that  is' necessary  in  order  to  lacreaM  the  flinetloa  of  an 
organ,  whether  of  seeretlon,  MasanoB,  or  inetion,  Is  a  moderately  Increased 


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CHOLERA,   CONSIDERED   AlfD  SXPLAINBD.  0 

2.  Sad  Food  and  bad  wftr.— When  these  causes  operate,  the 
chytne  and  chyle  are  vitiated,  and  the  nutrient  matter  they  furnish 
is  impure.  The  fluids  are  soon  altered  in  their  chemivSil  and 
physical  properties,  and  by  their  irritating  qualities  produce  a 
contraction  which  not  only  interferes  with  the  process  of  nutrition, 
but  with  all  the  flinctions,  consequently  affecting  the  general 
health,  and  bringing  the  system  into  the  condition  exactly  suited 
to  take  on  the  disease  when  subjected  to  the  influence  of  the 
specific  cause,  hence  the  great  liability  of  persons  thus  circum- 
stanced to  an  attack,  prior  to  which,  let  it  be  kept  in  mind,  the 
equilibrium  between  the  vessels  and  the  (.ores  was  not  disturbed  ; 
but  became  so,  immediately  on  the  application  of  the  specific  cause, 
when  the  disease  may  be  said  to  have  set  in.  The  several  ways  in 
which  bad  air  operates  to  predispose  to  the  disease,  that  is  in 
producing  this  contraction  of  the  capillaries  in  which  the  predis- 
position consists,  are  too  well  known  to  require  comment. 

9.  Sad  lodging} — deficient  clothing,  eapeciaUy  in  autumn, 
winter,  and  spring  ; — want  of  sleep,  over-exertion  and  fatigue. — 
The  pallor  induced  by  the  influence  of  these  causes,  evsn  when  of 
short  duration  (as  in  the  instance  of  one  or  two  nights*  watching), 
indicates  a  contraction  of  the  minute  vessels  which,  as  in  all  the  other 
instances,  predisposes  to  the  disease :  and  furthermore,  the  intensity 

determination  of  blond  to  it  Wlien  propjrljr  iF<t»tieated,  tlie  food  |m«w9  Into 
the  atoiDaeli,  on  the  inner  surfiice  of  which  It  mttkm  a  pleasant  impreMlon, 
which  indncei  that  organ,  the  stomach,  as  a  whole,  to  relax  for  the  eontlnned 
reception  of  the  tood  until  the  meal  Is  finished— and  what  the  su>mach  as  a. 
whole  dues,  that  all  Its  vessels  do,  and  they  admit  more  blood  ;  hence  the  secre- 
tion of  the  gastric  Juice  which  commences  soon  after  the  reception  of  food  into 
the  organ,  and  conUnues  until  K  is  all  digested  and  expelled  flrom  it,  when  after 
a  certain  tiir.s  the  contraction  Is  again  perceived,  the  perception  of  which  con- 
stitutes the  sensation  of  hunger,  which  is  commonly  most  argent,  when  the 
usual  period  for  taking  food  has  arrived ;  or  »  little  after,  when  the  contraction 
is  greatest  If  food  be  still  withheld,  the  stomach  relaxes  spoutoneously,  and 
the  semie  of  hunger  goes  ofl;  bat  returns  at  the  approach  of  the  next  an%l  time. 
The  stomach  may  be  made  to  talw  on  almost  any  habit  o!  periodicity  which 
will  best  suit  the  business  htbits  of  each  individual,  the  vessels  in  other  and 
distant  parts  doing  what  those  in  the  aUmentary  canal  do,  and  tnr  the  same 
reason— the  want  of  material  for  distension ;  emaciation  becomes  the  lecoBdary 
aad  Invariable  ceaeomltant  and  iwalt  of  daficieiMf  of  food. 


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10 


CHOLEBA,   CONSIDERED   AND  SXPLAIKED. 


of  any  one  of  them  may  prove  an  exciting  cause  in  the  case  of  any 
individual  upon  whom  the  choleraic  poiaon  ia  operating,  so  aa  to 
give  a  slight  indisposition  only.  ■<   r!i»' t'Oi ''«.•».•:  j     ,t)•J;«•.;,-.1^  a? 

4.  PreviouB  aieknesa  has  been  found  a  strongly  predisposing 
cause,  the  effect  of  which  is  a  contraction  of  the  capillaries,  so  very 
like  that  induced  by  the  foremeiitinned  causes,  as  to  render  further 
comment  unnecessary. 

5.  Affections  of  the  mind. — Fear ;  anxiety  and  dejection  of  spirits, 
which  are  species  of  fear  more  persistent  in  their  character,  pro« 
duce  contraction  of  the  capillaries,  as  is  proved  by  the  pallor  of 
those  subjected  to  their  influence,  and  therefore  powerfully  predis* 
pose  to  the  disease.  When  excessive,  these  aflections  and  pas- 
sions very  often  act  as  exciting  causes,  and  more  especially  so,  if 
the  predisposition  has  been  derived  from  the  choleraic  poison,  or 
specific  cause.  This  passion,  fear,  above  all  other  disturbing  causes, 
is  the  best  calculated  to  produce  the  disease,  for  it  not  only  causes 
the  capillaries  to  contract,  but  induces  the  pores  and  sphinetera  at . 
the  same  lime  to  relax— hence  the  diarrhoea,  and  diabetic  flow  of 
urine,  which  so  often  aflect  persons^ubjected  to  its  influence,  and 
so  far  as  my  own  observation  goes,  it  was  the  most  powerful  pre- 
disposing, or  frequently  exciting  cause  of  the  disease.  In  1832,  the 
predisposition  caused  by  this  subduing  passion  was  so  strong,  that 
almost  any  exciting  cause,  as  a  night's  watching,  or  a  meal  of  im- 
proper or  indigestible  food,  was  suflicient  to  produce  the  disease  in. 
all  its  horrors; — on  the  other  hand,  when  the  prediapositio.i  pro- 
ceeded fVom  other  causes,  and  particularly  the  specific,  a  fright,  or 
anything  that  occasioned  a  greater  sudden  mental  depression,  was 
sure  to  excite  the  disease.* 

*  This  passion,  by  turning  the  attention  inward,  and  fixing  !t  on  the  stomach 
and  lx>wels,  has,  in  addition  to  the  general  contraction  of  the  capillaries  which  It 
induces,  a  great  influence  as  an  exciting,  as  well  as  a  predisposing  eunse. 
One  ladjr  in  fall  health  was  introduced  to  the  bedside  nf  a  pitlent  in  the  worst 
form  of  Cholera.  AHer  witnessing  fbr  a  few  minntes  the  snflbrings,  she  became 
sick,  and  desired  to  be  helped  into  avther  room,  where  she  died  of  the  disease 
in  abont  five  hours.  By  mental  sympathy,  her  .attention  was  fixed  on  the  same 
parts  in  her  own  person  as  were  aflbeted  in  that  of  the  patient  whose  snflaring 
she  witnessed.  If  Inquired  of,  the  timid  will  tali  yon  that  they  are  prooo  to  this 
exercise  of  the  attention,  and  eiptrieM*  an  ajggravmtion  of  the  abdoninal  nneasi- 
ne3s  whenever  they  think  of  the  viscera  alhiiled  to. 


^^.wy  9yf 


CHOLBRA*  CONSIOEBBD   ANJ»  fiXPLAINEI). 


11 


6.  Intoxicating  Drink*. 

The  habitual  use  of  these  furnished  one  of  the  strongest  predis- 
posing caus  g  of  Cholera.    An  occasional  fit  of  intoxication,  in  such, 
as  indulged  in  this  most  pernicious  habit,  was  of  all  others  the  most  4, 
certain  exciting  cause  of  an  attack.     I  cannot  call  to  mind  a  singlo 
instance  in  which  an  habitual  drinker,  after  getting  drunk,  escaped 
an  attack,  or  one  who  recovered  from  it.     Although  it  may  not 
produce  any  palpable  derangement  of  the  health,  the  habitual  use 
of  intoxicating  drinks,  even  if  moderate,  as  in  the  case  of  temperate- 
drinkers,  so  called,  induces  an  irritable  state  of  the  capillaries, 
vbich  inclines  them  to  take  on  morbid  action  from  trivial  causes, 
and  that  condition  prevents  their  resuming  healthy  action  when  the 
disturbing  cause  is  removed.    In  other  words,  slighter  causes  bring 
on  disease  in  such  persons,  which  is  not  only  more  difficult  to  re- 
move by  medical  skill  and  remedies,  but  also  more  likely  to  destroy 
life.    For  the  reason  assigned,  it  will  be  easily  understood  why 
habitual  drinkers  are  so  much  more  certain  to  be  attacked  ak:d 
destroyed  by  the  disease,  than  the  tee-totaller,  who  so  uniformly 
goes  unscathed.*    He  that  takes  a  drop  of  anything  that  can  in-  > 
toxicate,  except  as  a  medicine,  has  in  the  opinion  of  the  author : 
"  taken  a  drop  too  much."  rt^iUv>riUi:^m^:.9^y&?m,^r,..^^m>^o 

7.  Hemorrhage.  •.\^..-\..   r:'..C.  ■.  ,.,•..,..  >:',    •'>;■> 
This  debilitates,  and  exhausts  the  system,  by  the  withdrawal  of 

its  fluids — consequently   produces  contractioq*of   the  capillaries 
commensurate  with  that  withdrawal. 

Spontaneous  haemorrhages  are  more  dangerous  and  much  more^ 
likely  to  give  the  predisposition,  and,  in  fact,  bring  on  the  disease,, 
than  such  as  are  accidental  or  produced  by  violence.    In  the  for-, 
mer  the  pores  are  open  (a  condition  analogous  to  that  which  actn.  , 
ally  exists  in  Cholera),  and  allow  the  blood  in  its  entirety  to  escape,  . 
and  the  vessels  continuing  to  contract,  keep  in  contact  with  what 
remains,  be  its  quantity  ever  so  small;  but  in  this  case  all  the  con- 
stituents of  the  'blood  equally  alike  escape  ;  and  there  the  analogy 
ceases.     In  Cholera,  the  colorless  portions  only  are  strained  out, 

*  It  t«  said  that  now  and  then  on*  of  this  claas  has  been  attacked— but  I  have' 
not  the  shadow  of  a  doubt  that  such  had  been  guilty  of  some  In-^mdent  act,  -, 
violating  tlio  lawi  of  health,  and  by  so  doing  invited  the  attack.  . 


-I 
III 


(^/i^P9^'^  ? 


m 


CHOLERAi  COTTSIDERED  AND  EXPLAmSD. 


1 

■  ! 

r'f 


Li 


^'1 


[<» 


and  the  residue,  partaking  of  the  nature  of  renous  blood,  remain*  in 
the  larger  vesselsi,  and  acts  as  a  poison  on  parts  with  which  it  in  in 
contact.  In  this,  as  in  other  instances,  the  contraction  of  the 
ocapillariea  constitutes  the  predisposition— the  flow  of  blood  the 
predisposing  cause.  In  spontaneous  htemorrhages  the  capillaries 
of  the  part  whence  comes  the  blood  are,  from  some  cause  or  other« 
over-distended,  which  prompts  them  to  contract,  and  if  they  do  not 
contract  violently,  the  pores  will  relax  and  allow  the  blood  to  pass, 
which  makes  room  for  more  and  more  to  be  admitted  into  the  ves- 
•els ;  so  that  the  fluids  of  the  body,  in  accordance  with  hydraulic 
principles,  finding  less  resistance  in  that  direction,  would  all  escape, 
if  proper  means  were  not  employed,  or  nature  did  not  interpose  to 
prevent  such  an  untoward  result.  In  both  the  accidental  and  spon- 
taneous  hemorrhage,  as  the  contents  are  withdrawn  the  vessels 
contract  and  keep  in  contact  with  those  \^hich  are  left. 

8.  Exposure  to  cold.  i  rfpwf« -*«?,« 

All  are  familiar  with  the  fact  that  cold  produces  contraction  of 
the  capillaries,  and  so  becomes  a  predisposing  cause  of  Cholera— 
but  many  instances  have  occurred  in  which  it  has  acted  as  an  exciting 
cause.  In  such  the  predisposition  has  been  the  work  of  the  speci- 
fic, while  an  additional  degree  of  contraction,  produced  by  the  ex- 
citing  cause,  exposure  to  cold,  ushered  in  the  disease.  ^ 

9.  Expoattre  to  the  night  air. 

It  seems  to  have  been  a  well  ascertained  fact  that  Cholera,  like 
endemic  diseases,  "generally  makes  its  attack  in  the  night  towards 
morning."  No  reason  known  to  the  writer  has  been  assigned  why 
this  time  for  attack  should  be  chosen.  To  him  the  following 
exposition  has  seemed  the  most  philosophical.  Natural  sleep  is 
caused  by  the  relaxation  of  the  capillaries  of  the  brain  and  nervous 
centres  first — next  of  those  belonging  to  the  organs  of  animal  life— 
and  lastly,  of  those  appertaining  to  the  organs  of  organic  life,  botin  a  ' 
less  degree  in  the  latter.  During  the  exertions  of  the  day  all  these 
vessels  are  more  or  less  under  the  influeiice  of  the  will  and  other 
exciting  causes,  which  are  wholly,  or  in  a  great  measure,  abstracted 
and  cease  to  operate  during  the  night ;  on  that  account  they  forego 
their  resistance  and  sufier  themselves  to  be  distended,  by  which 


t 

t*  ! 


^/^ff^  ^ 


CROLKRA,  COirSIDERBD  AffO  EXPLAIItED. 


It 


the  parenehTtnatous  substance  of  the  brain  is  compressed  and  sleep 
ensues.  Commensurate  with  that  distension  and  compression  is 
the  progress  of  sleep  from  slumbering,  dozing,  moderate  insensi- 
bility, to  deep  sleep,  coma,  tec,  and  in  the  same  degree  is  one 
function  of  animal  life  after  another  interfered  with  and  suspended, 
until  the  abolition  of  all  is  complete,  when  the  body,  failing  to  be 
supported  by  the  muscles  of  volition,  subsides  into  the  recumbent 
posture,  which  facilitates  the  additional  flow  of  blood  into  and  re- 
tards its  egress  from  the  brain.  Moreover,  favored  by  this  position, 
the  heart  continues  to  force  the  blood  into  the  capillaries  of  the 
brain,  and  likewise  into  those  of  other  parts  connected  with  animal 
and  also  organic  life,  whose  organs,  although  they  do  not  suspend 
their  operations  during  sleep,  perform  them  less  actively  and  vigor- 
ously,  and  in  that  way  share  in  the  benefits  of  sleep,  which  consti- 
tutes the  only  kind  of  repose  they  can  enjoy,  but  which  is  never- 
theless essential,  for  without  it  the*fa)achinery  of  life  would  soon 
cease  to  move. 

By  the  concurring  influence  of  the  forementioned  causes,  the 
natural  and  ordinary  sleep  which  we  are  now  considering  is  ren- 
dered more  profound,  and  might  be  detrimental,  and  even  fatal, 
if  nature  had  not  devised  a  method  by  which  it  is  commonly 
terminated  at  the  proper  time.  The  distension  caused  as  above 
described,  continues  to  increase,  until  the  vessels  of  the  brain,  and, 
indeed,  of  most  other  parts  connected  with  animal  life,  become 
more  and  more  distended  and  stretched,  till  active  resistance  is 
excited ;  and  then  contraction,  which  causes  uneasiness  and  some- 
times pain,  awakes  the  sleeper.  This  period  of  energetic  contrac- 
tion arrives  sooner  in  some  individuals  than  in  others,  but  generally 
towards  morning,  when  people  who  "follow  nature"  become 
uneasy  and  begin  to  awake.  ' 

Thus  far  all  is  well — the  relaxation,  distension,  compression, 
contraction,  and  attendant  circumstances,  as  detailed,  are  normal, 
and  would  induce  neither  cholera  nor  any  other  malady  without  the 
concurrence  and  co-operation  of  another  exciting  cause  or  extra- 
neous agent,  which  prevents  the  contractile  effort  just  mentioned 
fVom  stopping  at  the  point  where  it  has  performed  the  duty 
assigned,  i.  e.  when  it  has  wakened  the  sleeper.     This  cause  is  a 


I  I 

I  I 
i  1 


^/'<^,r>^P  S' 


/ 


i  /- 


u 


CHOLERA,  CONSIDERED   AND  EXPLAINED. 


Jl 


1 


,1 

,1 


change  io  the  temperature  uf  the  i^osphere,  which  takes  place 
•imulraneously  with  that  ia  the  bodj.    This  atmospheric  change 
consists  in  a  fall  of  temperature  and  consequent  condensation  and 
depositor  moisture  during  the  night,  and  particularly  the  lattefu: 
part.     Owing  to  this  diminution  of  temperature  in  the  surrounding- 
air,  caloric  leaves  the  body,  which  causes  the  cutaneous  capillaries 
to  contract  still  more,  and  with  increased  energy.    Induced  by  the 
joint  influence  of  these  two  causes,  to  which  is  usually  added  that 
of  other  predisposing  and  exciting  causes,  and,  abnre  all,  that  of 
the  specific  or  choleraic  agent,  this  contraction,  "  about  three  o;'.;} 
four  o'clock  in  the  morning,"  ushers  in  the  nocturnal  attack  of 
cholera,  and  likewise  that  of  many  other  diseases,  beginning  with  . 
a  chill/ 

With  respect  to  them  the  contractile  effort,  as  in  cholera,  does 
not  stop  with  the  awakening  of  the  sleeper ;  but,  influenced  by  the 
co-operation  of  the  predisposing  and  exciting  causes,  whether  of 
fever  and  ague  or  of  any  other  disease,  it  goes  on  with  incxeasing 
energy  until  those  affections  are  induced.  In  cholera,  although  the 
disease  commenced  at  the  time  stated,  the  cold  stage  is  Hot  often  v 
fully  established  until  after  the  lapse  of  several  hours.  So  the,;, 
cold  stage  of  fever  and  ague  and  of  other  fevers  does  not  often ;  ; 
manifest  itself  before  nine  or  ten  o'clock  in  the  morning,  or  later, 
according  to  the  tyoe.  It  will  be  seen  that  this  view  of  the  subject 
is  in  strict  accorditce  with  those  already  taken  in  regard  to  the 
predisposing  and  exciting  causes  to  which  allusion  has  been  made. 
The  coincidence  of  this  contractile  effort  of  the  capillaries  at  that 
period  of  the  twenty-four  hours  when  the  temperature  of  the 
atmosphere  and  the  condensation  of  its  moisture  are  at  the  lowest 
point,  secures  that  degree  of  capillary  contraction  which,  with  the 
co-operation  of^  the  other  predisposing  and  exciting  causes,  renders 
the  influence  of  the  specific  poison  so  certain,  that  persons  if  only 
slightly  predisposed  will  be  attacked  at  the  time  specified.  Many, 
it  is  true,  ari3  assailed  during  the  day,  but  in  such  cases  the  disease 
springs  from  some  special  and  strongly  exciting  cause,  as  intoxica-  * 
tion,  fright,  over-exertion,  &c.  ,^  ^      tiij-    J     >•    l*. 

*  Thts  view  of  the  subject  suggests  the  propriety  of  an  extra  blanket  at  night 
applied  nt  least  over  the  inferior  eztreinltles. 


<pr9.pf 


'^/ 


\:   \ 


■\' 


CHOLERA,  CONSIDEBC:^^  AND  SXPLAINBD. 


15 


This  explanation  affonU  tome  important  practical  deductions,  of 
which  v-^  shall  avail  ounelrea  when  we  come  to  constider  the  treat- 
mer.t 


. <■  i -J r;'',!^;  rri'. 


,»AUytT>*" 


*)   f 


If.  OF  THE  SPECIFIC  CAUSE  OF  CHOLERA. 


Concerning  this  agent  we  are  in  the  dark ;  but  are  much  inclined 
to  consider  it  a  predisposing,  rather  than  a  necessarily  exciting 
cause.  In  whichever  light  it  is  viewed,  it  is  consoling  to  know 
that  it  is  seldom,  if  ever,  so  highly  concentrated  as  to  produce  the 
disease  without  the  concurrence  and  co-operation  of  some  one  or 
more  of  the  causes  belonging  to  the  class,  which  we  have  just 
been  considering ;  but  when  so  concentrated  as  to  become  the 
rqal  exciting  cause,  it  seizes  its  victim  without  the  least  pre- 
monition, and  hurries  him  with  relentless  fury  and  awful  celerity 
to  "  that  lone  land"  from  "  whose  bourne  no  traveller  returns." 
Bat  it  is  comforting  to  know  that  such  instances  are  very  rare ; 
and  that,  although  millions  may  fall  by  the  sword  of  the  de- 
stroyer, yet  the  cases  just  alluded  to  are  almost,  if  not  quite,  the  only 
ones  necessarily  fatal.  Without  offering,  in  this  place,  anything  re- 
lating to  this  strange  mysterious  agent,  we  shall  proceed  to  analyze 
the  phenomena  which  it  produces,  and  try  to  deduce  from  them 
something  concerning  its  nature,  and  the  laws  by  which  its  influence 
on  the  human  body  is  governed,  and  the  principles  of  practice  on 
which  we  should  rely  in  the  treatment.  Here,  however,  a  difficulty 
meets  us  un  the  very  threshold — it  is  that  of  discriminating  between 
the  phenomena  which  proceed  directly  from  the  specific  cause,  and 
those  produced  by  the  modifying  influences  of  the  other  causes; 
and  also,  between  those  induced  by  other  causes,  modified  by  the 
choleraic  or  specific  cause.  The  premonitory  eymptoms,  as  they 
are  technically  called,  arising,  as  we  believe  they  do,  from  the 
common  predisposing  and  exciting  cause.i,  furnish  the  best  and 
moat  characteristic  mark  of  distinction,  which  is  of  the  utmost 
practical  importance. 

Like  the  predisposing  and  exciting  causes  which  we  have  been 
considering,  and  also  like  those  of  epidemics  and  endemics,  this  spe- 
cific cause  or  choleraic  agent  produces  a  vehement  contraction  of  the 
capillaries  throughout  the  whole  body,  especially  thoso  portions  of 


t] 


h 


/  / 


♦! 


16 


CHOLERA    CONSIDERED  AND  EXPLAINED. 


i 


IfSil 


it  which  belonfi;  to  animal  life ;  but  in  one  respect  iti  eflTeet  diflfcra 
Trom  that  of  the  others,  and  ia  indeed  peculiar  to  itaelf.  With  thia 
constriction  of  the  minute  veasrls,  it  also  eausea  a  relaxation  of 
theporea,  particularly  those  openini;  into  the  stomach  and  bowels, 
throuKh  which  the  colorless,  aerous,  and  aaline  constituents  of 
the  blood  escape  into  those  viscera,  and  leave  the  system  destitute 
of  materials  essential  to  the  performance  of  the  vital  functions. 
Thia  lest  circumstance,  the  relaxation  of  the  pores,  we  repeat,  ia 
the  great  leading  mark  of  distinction  between  the  efTecta  of  this 
and  the  eflfects  of  the  other  caunes,  which  we  have  considered  as 
predisposing  and  exciting,  and,  indeed,  of  all  other  morbific  agen- 
cies ;  and  in  that  circumstance,  viz.  the  relaxation  of  the  pores 
taking  place  simultaneously  with  the  contraction  uf  the  capillaries, 
consists  the  peculiar  and  specific  action  of  this  choleraic  agent, 
and  it  is  this  anomalous  and  u'.lque  effect  which  constitutes  chole- 
ra  a  disease  mi  gentria.  '*■'!'  ** «»' 

It  is  true  that  we  have  the  contraction  of  the  capillaries,  and 
occasionally  a  relaxation  of  their  outlets  from  other  causes,  as 
when  cathartic  medicines  are  administered  for  when' causes  of 
diarrhcea  exist  within  the  alimentary  canal, — which  irritate  the 
mouths  of  the  exhalants  (as  tobacco  irritating  the  extremities  of 
the  salivary  ducts  causes  an  increased  flow  of  saliva),  and  cause 
them  to  pour  out  their  contents,  hence  the  diarrhoea  fVom  such 
causes.  But  the  diarrhoeas  from  fear  and  the  application  of  cold 
to  the  fl"rface  are  more  analogous  to  that  produced  by  the  specific 
cause  of  Cholera,  than  those  produced  from  the  causes  just  men- 
tioned. In  all  the  cases  mentioned,  the  diarrhoea  is  generally 
either  mucous  or  purulent,  and  therefore  does  not  much  involve  the 
capillaries  which  circulate  the  albuminous,  serous,  and  watery  por- 
tions of  the  blood  ;  neither  does  it  affect  so  great  an  extent  of  the 
mucous  surface  of  the  alimentary  tube.  sii* 

Let  us  now  examine  the  symptoms  and  phenomena  ;  1,  with  t 
view  to  their  cause ;  3,  to  the  proximate  cause  of  the  disease ;  and 
3,  to  the  treatment.  "«i»i 

In  a  great  many  instances,  perhaps  a  majority,  the  disease  aeenis 
to  commence  in  the  organs  of  animal  life,  hence  the  languor,  pale- 
ness, and  contracted  state  of  the  features  which  often  precede  an 
attack.     Thia    Choleric  expression  was  so  remarkable  that  the 


1 


CHOLKRA,  CONSrDBRBD   AND   EXPLAINED. 


n 


ifftra 
this 
•on  of 
wels, 
its  of 
ititute 
tions. 
sat,  i« 
if  this 
eda« 
agen- 
poret 
llariea, 
agent, 
chole- 


eecession  of  the  disease  wa»  often  anticipated,  and  in  dome  caaea, 
as  the  writer  believes,  prevented.     The  shrinking  of  the  cutaneous 
capilluricfl    which    belong    to    animal    life,  constitutes   a  most 
remarkable  feature  of  the  disease,  and  is  the  physical  cause  of  one  of 
its  prominent  symptoms— the  sensation  of  cold.     In  Cholera,  this 
sensation   is  no  error  of  perception,  for  the  temperature  of   the 
body,  internally  as    well  as    externally,  is  excessively  lowered, 
and  the  capillaries  no  less  excessively    contracted,    as  may  ba 
inferred  from  the  coldness  of  air  breathed  from  the  lungs,  and  the 
corrugated,  shrunken  appearance  of  the  surface.    We  know  no 
ap^lisAce   to  the  body  that  can  produce  this  effect.     External 
agencies  seem  to  be  utterly  incompetent,— the  cause  must  then  be 
one  acting  from  within,  and   here   again  we   are  constrained  to 
acknowledge  our  ignorance  of  any  substance  taken  into  the  system 
which  can  produce  such  a  result.     Nothing  but  caloric  leaving  the 
body  (and  in  Cholera  it  escapes  with  a  wonderful  facility),  can 
produce  this  general  reduction  of  temperature  with  which  the 
capillary  contraction  seems  to  be  exactly  commensurate ;  but  the 
mere    abstraction     of    caloric    does    not— cannot    produce    the 
phenomena  of  Cholera,  because  life  would  be  extinguished  before 
the  capillaries  of  the   internal  organs  could  be  made  to  feel  its 
induance;  besides.  Cholera,  like  intermittent  and  endemial  fevers 
and  diseases,  invades  the  system  at  times  and  under  circumstances 
which  preclude  the  possibility-  of  an  abstraction  of  caloric  which 
could  per  ae  produce  the  shrinking  of  the  capillaries  and  other 
phenomena.    The  analogy  must  not,  however,  be  permitted  to 
escape  us.     Cold  applied  to  the  body,  or  more  scientifically  speak- 
ing, calorie  alstracted  from  its  surface,  produces  a  contraction  of 
Um  cutaneous  capillaries,  and  also  those  more  deeply  seated,  which 
forces  the  fluids  inward    upon    the  capillaries  of    the  mucous 
membranes,  and  causes  them  to  be  slightly  over-distended,  but  not 
enough  to  induce  the  pores  opening  into  the  intestinal  canal,  to 
resist,  and  hold  fiut,  because,  owing  to  the  unvarying  warmth  of 
the  part  they  are  ever  ready  to  relax,  and  do  relax  as  the  capillaries 
contract ;  hence,  the  looseness  which  is  so  apt  to  follow  the  simple 
exposure  uf  tha  nude  body  to  the  cold  water,  or  the  cool  air  pre-, 
paratory  to  bathii^  and  axplaina  the  reason  why  cold  is  so  often  an 
exciting  cause  of  Cfadara.    In  tha  same  way,  aqd  on  the  satne 


« 


CUOLEEJi,  C02«8IJ}£R£Z)   AND  EXVLMKZD. 


*    i 


III 


:l . 


principle,  is  the   quantity   of  urine    increased  and  the  desire  to 
mictorate  from  a  similar  exposure. 

Analoefous  to  this  effect  of  cold  is  that  of  fear,  which  produces  a 
contraction  of  tho  cutaneous  capillaries,  and  a  relaxation  of  the 
sphincters;  hence  the  diarrhoea,  and  desire  to  micturate  when  per- 
sons are  much  under  its  influence,  complaints  said  to  have  been 
prevalent  among  the  higher  otBcers  engaged  in  the  late  "  patriot 
war"  along  the  Canada  frontier.  Men  of  great  laxity,  they  were 
undoubtedly  thoroughly  predisposed,  and  would  certainly  have  had 
Cholera,  had  it  been  at  all  prevalent.  This  explains  the  fact  why 
fear  is  one  of  the  most  powerfully  exciting  causes.  The  specific 
cause,  whatever  it  may  be,  produces  a  peculiarity  of  eflect  which 
constitutes  Cholera  a  disease  sui  generis ;  but  it  must  be  admitted 
that  the  causes  of  other  diseases  do  sometimes  produce  analogou* 
effects. 

Some  have  supposed  the  specific  cause  to  be  a  change  wrought 
in  the  constitution  of  the  blood ;  but  that  hypothesis  falls  to  tfa^ 
ground  when  we  consider  the  fact,  that  the  disease  is  very  certainly 
arrested  and  cured  in  its  premonitory  stage»,by  remedicB  which: 
cannot  be  supposed  to  operate  any  cl\ange  vrhatevor  in  the  physical 
or  chemical  properties  of  the  blood ;  and  moreover,  tli«it  it  is  occa> 
sionally  recovered  from  in  all  its  stages,  under  the  use  of  meadui 
which  effect  no  such  changes. 

Besides,  it  i9  said  that  persons  in  perfect  health  have  been 
attacked — and  also  that  recovery  is  now  and  then  sudden;  facts 
inconsistent  with  the  idea  of  the  existence  and  removal  of  such  a 
condition  of  the  blood.* 

Man  in  his  wisdom  ia  prone  to  look  beyond  tl^e  .simplicity,  of 
nature,  in  the  explanation  of  the  phenomena  which  she  present*, 
and  more  particularly  so,  when  the  phenomena  of  disease  are  con- 
cerned;, but  the  writer,  after  much  reflection,  jias  at  length  settled 
down  upon  what  ^eeipa  to  him  to  be  the  most  simple  and  Qommon 
sense  view  of  the  subject,  vyhich  is  that  the  specific  capse  of 


*  That  the  blood  does  undergo  nhanges  daring  the  progress  of  the  disease,  is 
not  to  be  questioned.  That  fluid  drawn  soon  after  the  attacic  is  natnriii — bat  if 
at  »  later  period,  "darli,  black,  tanrj^— thicic,  ropy,  syra^,  semi-eoagalated,*> 
changes  owing  mainly  to  the  straining  out  through  tlM  pent,  of  the  edorlesa 


and  ui;ous  ]|orUpnto(.the.li|ood,  as  the  dlwase  advancad. 


-'.  HI 


:.0 


=*;.•' 


Wl 


CHOLERA,  CONSIDERED  AND   EXPLAINED. 


19 


esire  tu 

duces  a 
of  the 
)en  por- 
ave  been 

*  patriot 
ley  were 

lave  had 
fact  why 
»peeifio 
ct  whiclk 

admitted 
BDalogous 

i  wrought 
Us  to  th9 
I  certaioJiy 
icEi  which.' 
e  physical 
it  is  occa- 
i  of  metiDs 

have  b«fln 
Iden;  facts 
I  of  such  a 

uplicity.  of 
e  present^, 
tse  are  con-^ 
igth  settled, 
id  qommon 
ic  cause  of 


Cholera  is  the  concurrent  influence  of  all  or  moat  of  the  predispos- 
ing.and  exciting  causes  of  that  malady,  while  those  agencies  whoso 
tendencies  are  to  counteract  that  influence  are  absent.  Not  that 
the  concurrence  of  all  is  necessary  to  the  production  of  the  disease 
in  each  individual  case,  but  that  the  existence  of  all,  or  nearly  all, 
is  necessary,  as  in  other  epidemics,  in  otder  to  render  the  disease 
general.  When  these  causes  exist  in  any  place,  it  may  be  expected 
that  Cholera  will  soon  be  there.  When  they  are  removed  in 
season  (and  they  are  all  indigenous,  and  under  our  control),  the 
disease  either  does  not  make  its  appearance,  or  soon  disappears. 
When  it  breaks  out  under  such  circumstances,  the  timid  stiould 
flee  and  the  poor  be  removed. 

We  have  shown  in  a  former  part  of  this  papery  that  the  predis* 
posing  and  exciting  causes  all  concur  in  producing  a  contraction  of 
the  capiUaries;  but  that  the  disease  was  not  produced,  unless  the 
pores  opening  into  the  alimentary  canal  were  relaxed.  It  may  be  a 
question,  to  what  class  of  capillaries  do  these  pores  belong  f  We 
answer:  not  to  those  which  perform  th€i  ordinary  Ainctions  of 
secretion  or  excretion,  whiok'  pertain  to  the  lining  membrane  of 
that  canal,  but  to  those  that  circulate  the  colorless  fluids,  as  the 
albumen,  serum,  and  fibrine— constituents  of  the  blood.  When  the 
contraction  of  the  capillaries  over  the  system  which  belong  to  this 
class  takes  place,  and  the  above  mentioned  pores  connected  with 
them  in  the  mucoUS'  membraoet  relax,  we  have  Cholera;  Another 
question  arises.  How  are  wo  to  account  for  the  coincidence  of  the 
contraction  of  the  ca{)illaries,  and  the  celaxatiMi  andepening  of  th« 
pores  ?  .  • 

We  will  venture  to  Suggest  that  the  coocurrent  influence  of  the 
causes  to  which  we  have  alluded  as  the  speeific  canse,  when  it  pro- 
duces  the  disease,  does  it  by  disturbing  the  equilibrium  between 
some  of  the  imponder9ble  agents  which  pervade  the  human  frame, 
in  common  yrith  everything  else,  a  disturbance  which  is  capable 
of  extinguishing  life,  or  greatly  deranging  its  functions.*  '  i^-  ^ 


'A 


he  disease,  is 
atural— but  if 
1 -coagulated,'* 
"the  ccriorISM 


*  Perhaps  philosophy  may  yet  disclose  what  will  be  la  perfect  keeping  with 
the  simplicity  of  nature,  that  these  imponderable  agents  called  caloric,  light, 
galvanism,  electricity,  magnetism,  toe.,  are  only  ii^odiflcations  of  the  same  aipnt, 
and  governed  by  the  same  laws.    Probably  thjs  opinion  now  prevails. 

V 


f 


I' I    ' 
P'll    ■ 


'       • 


it 


^i  - 


30  CHOLERA,   CONSIDEBBD   AND   EXPLAIITED. 

■■-/■'■■         ■■'.'."•"  '■' "     SYMPTOMS.     ■-"■^■'■'•■J  ■  •»  t    /•.'»<•.:.' 

In  Cholera  we  have  nausea,  vomiting,  and  purgin)^,  with  violent 
cramps  in  the  stomach  and  gripings  in  the  bowels,  also  dreadful 
spasms  in  the  muscles  of  the  abdomen  and  limbs,  and  various 
other  symptoms  not  imputable  to  the  specific  cause  alone,  and  there' 
fore  explicable  on  other  principles,  a  consideration  of  importance  in 
relation  to  the  treatment.  "   ^"if  }"■■;'■'■■.'■  "^" 

1.  VomUing  and  purging. — What  the  capillaries  of  the  stomach 
and  bowels  do,  no  matter  from  what  cause,  that  will  those  viscera 
as  entire  organs  do;  therefore  when  those  vessels  contract  and 
force  their  contents  through  the  pores  into  the  cavities  of  these 
viscera,  they  (the  viscera)  will  be  prompted  to  contract  as  whole* 
by  this  contraction  of  their  vessels,  and  by  the  contained  fluids, 
which  act  by  their  irritating  qualities,  and  likewise  by  their  bulk,  in 
both  ways  exciting  the  stomach  and  bowels  to  violent  e£fbrts  for 
their  expulsion ;  hence  the  vomiting  and  purging,  and,  when  violent, 
the  cramps  and  gripings,  so  characteristic  of  cholera.  The  quan> 
tity  of  contents  produces  mechanical  distension,  the  natural  stimu- 
lus to  the  muscular  fibre,  hence  the  muscular  coats  of  those  organs 
take  on  abnormal  actions  which  are  so  painful  and  overwhelming. 

2.  Crampt  and  npasma — Now,  according  to  a  law  of  sympathy, 
when  the  muscles  in  one  part  become  inordinately  affected,  those  in 
other  parts,  from  similarity  in  structure,  are  in  like  manner  affected. 
In  Cholera  the  muscles  of  locomotion  do  what  the  muscular  tissues 
of  the  stomach  and  bowels  do,  consequently  cramps  and  spasms 
manifest  themselves  in  the  limbs,  which  result  from  the  contrac- 
tions of  the  capillaries  of  those  muscles,  in  accordance  with  the 
law  that  muscles  as  wholes  do  what  all  their  capillaries  do.  These 
cramps  are,  however,  very  unlike  the  spasms  in  epilepsy  and  con- 
vulsions, which  are  instituted  by  nature  as  remedial  measures  for 
relieving  the  congested  state  of  the  brain,  by  deriving  blood  from 
that  organ  into  the  muscles  of  locomotion.*    In  Cholera  these 

*  This  is  on  the  principle  that  Increasing  the  function  of  an  organ  within  cer- 
tain liinits  augments  the  detenulnation  of  blood  to  that  organ,  hence  in  epilepsy 
and  SQuvalilons  ths  abnormal  action  of  the  mustlas  causes  an  Increased  quan- 


tity! 
tedi 
thall 

thatf 
Insti 

opilJ 


CHOLEBA,  CONSIDBBBD  AND  EXPLAINBD. 


31 


iriolent 
readful 
irariout 
I  there- 
ance  in 

itomach 
1  viscera 
act  and 
of  theae 
I  wholw 
1  fluids, 
r bulk,  in 
fibrta  for 
1  violent) 
16  quan- 
alatimu- 
le  organs 
helming. 

ympathy, 
,  those  in 
r  affected, 
lar  tissues 
id  spasms 
e  cOntrac- 
B  with  the 
lo.   These 
y  and  con- 
saMures  for 
jlood  from 
tlera  these 

a  within  cer- 
•A  In  epilepsy 
iroased  ^aan- 


irregular  movements  arise  from  the  violent  efforts  of  the  muscular 
capillaries  to  follow  up  their  contents,  which  are  being  so  rapidly 
withdrawn.  They  resemble  the  convulsive  motions  of  animals 
dying  from  loss  of  blood. 

3.  The  Small  Feeble  Pul»e—\i  owing  to  the  contracted  condi" 
tion  of  the  capillaries  of  the  heart ;  a  condition  sympathetic  of,  and 
analogous  to  that  of  those  vessels  in  othri*  parts.  In  this  case,  the 
heart,  doing  what  all  its  capillaries  dc.  becomes  so  contracted  that 
it  cannot  send  the  blood  to  distant  parts  with  sufficient  force  to 
overcome  the  contracted  state  of  the  capillaries  (its  antagonists), 
over  the  whole  system,  even  if  this  extraordinary  capillary  resist- 
ance did  not  exist — hence  the  pulse  not  unfrequently  ceases  to  be 
perceptible  several  hours  before  death.  Desperate  as  the  case  may 
seem,  if  the  capillaries  relax,  the  patient  may  recover.  It  is  then 
proper  to  keep  up  to  the  last  external  warmth,  dry  friction,  &c., 
which  promote  relaxation. 

4.  Dyspntfa.—"  The  Dyspnoea,  the  high  and  rapid  breathing,  and 
intolerable  sense  of  oppression,"  arisu  from  the  contracted  state  of 
the  capillaries  of  the  lungs,  and  also  of  the  muscles  of  respiration, 
sympatheticdlly  produced  ;  the  former  excluding  blood  from  those 
organs,  and  thereby  preventing  its  due  aeration;  and  the  latter, 
the  proper  performance  of  the  respiratory  act,  so  far  as  it  depends 
on  the  apparatus  essential  for  that  function. 

5.  State  of  Mind. — The  capillaries  of  the  brain,  the  organ  of 
mind,  like  those  of  other  parts,  are  in  a  state  of  inordinate  contrac- 
tion, as  may  be  inferred  from  the  constricted,  uhrunk,  shrivelled, 
and  pallid  appearance  of  the  face  and  features,  which  is  usually  a 
sure  index  to  the  circulation  of  parts  within  the  cranium,  be- 
cauie  both  derive  their  blood  from  the  same  vessels.    The  state  of 

tlty  of  blood  to  be  derived  to  them,  and  tn  the  tame  proportion  as  Mood  is  admit- 
ted into  them  is  it  withdrawn  from  the  brain— hence  the  relief  experienced  by 
that  organ.  In  this,  natnre  does  what  the  practitioner  does  with  h*'  lancet, 
leeches,  scarificator,  pedlinviain,  trlctluns,  Uc.  A  resort  to  these  means  proves 
that  he  has  rightly  interpreted  the  indications  and  language  of  nature.  In  many 
instances  a  l^jeral  dose  of  opium,  when  immediately  preceded  by  a  fall  bleed- 
ing, by  the  general  rslaMtion  It  produoea,  puts  aa  end  to  the  convuUloni  or 
oplleptlc  paroxysm.  .  , 


11 


I 


r 


92 


caOLERA,    .     <SIDERED   AND   EXPLAINED. 


the  mind,  which  is  somewhat  analo|;ou9  to  that  of  a  person  sufTcr- 
ing  from  extreme  cold  or  a.serious  injury  from  external  violence. * 
I  have  often  made  the  comparison,  and  contemplated  the  resem- 
blance with  great  interest,  as  a  proof  :)f  the  condition  of  the  ence- 
phalic capillaries.  The  disease  advancing,  the  patient,  though  not 
insensible,  is  indifferent  to  everything  about  him, — has  little  per- 
ception— little  volition — is  indisposed  to  action  or  exertion,  and, 
therefore,  performs  no  intellectual  operations,  although  conscious 
of  whatever  is  passing  around  him.  He  usually  retains  his  mental 
faculties,  though  in  a  subdued  condition,  to  the  last ;  but  is  exceed- 
ingly disinclined,  •-..  probably  unable,  to  exert  them — the  contrac- 
tion of  the  cerebral  capillaries  being  too  strong  to  be  overcome  by 
any  effort  he  can,  or  is  disposed  to  make.  Indifferent  and  uncon- 
scious, he  seems  to  wait  the  catastrophe  in  a  kind  of  insensate,  non- 
caring  mood.  To  obviate,  or  prevent  the  approach  o'  .his  state  of 
things,  the  most  strenuous  endeavor  should  be  made  to  keep  up 
confidence  in  the  use  of  efforts  and  remedies.  So  long  as  the  pa- 
tient himself,who  is  probably  not  as  indifferent  as  he  appears,  hopes, 
there  is  hope  in  his  case  ;  when  he  despairs  he  will  certainly  die — 
do  what  you  will.  ;:       .         , 

6.  Insensibility. — Nearly  allied  *o,  and  perhaps  dependent  on, 
the  foregoing,  is  that  want  of  sensibility  which  is  so  frequently 
witnessed  several  hours  before  death,  which  is  owing  to  the  parts 
connected  with  animal  life  having  been  deprived  of  their  arterial 
blood  by  the  contraction  of  fh"^  capillaries; — the  sensibility  of  a 
part  being  in  direct  proportion  to  the  quantity  of  arterial  blood 


I*  We  are  told  that  patienta,  particularly  in  India,  whilo  wallcing  in  tlie  open 
air,  fell  down  wtiU  symptoms  of"  vertigo,  deafness,  and  blindness,"  and  expired 
in  a  few  r-iiiutes.  These  were  exami)les  of  tho  disease  being  indnced  by  the 
direct  and  concentrated  agency  of  the  specific  cause,  whatever  it  may  have 
been,  which  produced  such  a  rapid  and  intense  contraction  of  the  cupillaries  of 
the  brain  and  other  vital  organs  by  sympathy,  as  %o  stop  almost  instantly  the 
wheels  of  life. 

It  has  been  remarked  by  writers  that,  when  any  peculiariiy  as  the  above, 
manifested  itself,  it  uniformly  oontln  led  to  prevail  in  the  places  where  it  first 
appeared,  and,  indeed,  seemed  to  be  confined  to  them,  a  fact  which  goes  to 
prove  that  local  causes  have  &  cUongly  modifying  Influence  over  the  specific 
cause  and  its  effects.  - '•''    ~<.  i.-i|  vuii,  3u<.  > 


m 


*i 


CHOLERA,  CONSIDERED    AND   EXPLAI.NEU. 


23 


circulating  in  it.*  Deprived  of  blool,  an  nrjnn  or  part  becomes 
insensible.  The  stomach,  when  in  that  predicament,  is  quite  n"  in  • 
sensible  as  the  surface  to  the  strotrj;cst  stimuli. f  This  insensibility 
<*f  the  stomach  does  not  usually  occur  until  after  the  vomitinj^  and 
purging  have  ceased.  Notwithstuidinsj;  the  coldness  of  ti>e  surface, 
tongue,  and  breath,  the  patient  frequently  comphins  of  a  sense  of 
heat  and  burning  at  the  stomach — pircumstances  expliiinable  on  the 
principle  that  extremes^  often  produce  similar  results. 

7.  Deficient  Secretion  of  Urine. — Omn^  to  the  contracted  state 
of  the  renal  capillaries,  the  blc  is  excluded  from  the  kidneys, 
and  no  urine  is  secreted ;  and  frnra  a  similar  condition  of  those 
vessels  pertaining  to  the  bladder,  that  viscuti,  doing  what  all  its 
capillaries  do  or  have  done,  is  found  as  a  whole  in  a  state  of 
extreme  contraction.  I  have  seen  it  not  larger  than  a  butternut, 
and  containing  not  a  single  drop  of  urine.  ;■  -v«-  •v.  /  .  ; 

8.  Secretion  «f  Bile. — The  veins,  hepatic  and  mesenteric,  are 
gorged  with  dark-colored  blood — i  necessary  result  of  our  theory  of 
the  contraction  of  the  capillary  system  By  tlie  capillary  contrac- 
tion in  other  parts,  the  blood  is  forced  inward  upon  the  veins  and 
capillaries  of  the  stomach  and  bowels,  and  its  thinner  and  more 
subtile  portions  are  strained  out  through  the  pores  into  the  alimen- 
tary canal,  while  its  thicker  and  grosser  parti  remain  in  the  veins. 
Now  these  veins  having  no  valves,  and  little  support  from  the  sur- 

*  The  sensibility  of  a  part  being  uindlficd  by  the  state  of  its  circulation,  holds  as 
well  in  Iho  nornai  and  healthy,  us  in  the  abnormal  and  morbid  condition.  Wit- 
ness tito  bones,  curtilages,  fibrni^  membranes,  Sec,  which  in  a  natural  state 
ezclnde  red  blood,  and  are  insensible,  but  if  red  blood  is  admitted,  as  in  inflam- 
mut'on,  they  becorao  excessively  painf«i :  other  parts,  as  the  ends  of  the  fingers, 
iip^,  &c.,  replete  with  vessels  circulating  arterial  blood,  are  acutely  sensitive, 
both  in  health  or  disease. 

t  This  insensibility  of  the  skin  during  the  state  of  coll.ipse,  as  It  is  called.  Is  in 
some  iiistiinces  so  great  that  blisters,  and  even  cloths  wrsng  oat  in  boiling  water, 
m;tl(0  little  or  no  impression.    The  capillaries  ennoot  relax. 

i  If  we  apply  a  piece  of  frozon  mercury,  or  a  piece  of  iron,  heated  as  ranch 
above  blood  heat  (i.e.  to  137|  Fah.)  as  the  mercury-  when  congealed  is  cooled 
beluw,  the  subject  of  the  exi)criment  cannot  tell  by  the  feeling  which  is  the 
heated  iron  or  the  cooled  mercury— tlie  sensations  and  effects  will  be  llio  game- 
in  both,  a  blister  will  be  the  consequence.  This  is  fVilly  substantiated  by  the 
testimony  of  Capt.  Parry.    Bee  Narrative  of  a  Voyage  in  quest  of  the  North  Pole. 


i  !l 


r 


24 


If  I 
Hi! 

:l;f!i 


I 


CHOLERA,   CONSIDERED    AND   EXPLAINED. 


rounding  viscera,  and  also  little  or  no  help  but  rather  resistance 
from  the  pulmonary  and  cardiac  vessels,  are  incapable  of  moving 
the  blood  along  their  trunks,  hence  their  engorgement.  In  conse- 
quence of  this  excess  of  blood  in  the  portal  and  hepatic  veins,  a  re- 
dundancy of  bile  is  suddenly  secreted,  and  the  gall-bladder  no  less 
suddenly  distended,  or  over-distended,  and  therefore  cannot  and 
does  not  empty  itself  through  its  excretory  duct  into  the  duode- 
num, and  is  consequently  found  full,*  and  no  bile  in  the  intestines, 
and  moreover  none  in  the  profuse  evacuations  during  the  progress 
of  the  disease.     How  in  such  cases  could  calomel  affect  the  liver.' 

9.  Dark  appearance  of  the  Skin. — When  the  surface  of  the 
body  exhibits  the  dark  blue  appearance  mentioned  by  writers,  and 
universally  witnessed  by  all  who  have  seen  much  of  Cholera,  the 
mesenteric,  portal,  and  hepatic  vei,  i  are  seldom  much  gorged  with 
blood,  and  vice  versa — they  are  generally  distended  with  that  fluid 
when  that  appearance  is  absent.  This  dark-colored  appearance, 
although  mentioned  by  writers  as  a  symptom  of  cholera,  is  by  no 
means  uniform,  or  according  to  the  writer's  observations,  even 
general — but  rather  the  exception  than  the  rule,  and  occurs  only 
when  the  visceral  veins  are  undistended.  When  absent,  the  inter- 
nal veins  are  gorged ; — when  present,  comparatively  empty.  Our 
theory  explains  this. 

10.  Msence  of  Vomiting  and  Purging. — Cases  are  recorded  in 
which  there  was  neither  vomiting  nor  purging ;  yet  the  stomach 
and  b  wels  were  full  of  the  rice  water  fluid.  In  such,  the  emptying 
of  the  capillaries  of  those  organs  had  been  effected  mainly  by  the 
relaxation  of  the  pores  wi.nout  much  contractile  effort  on  the 
part  of  the  capillaries.  The  exhaustion  of  nervous  power  had 
prevented  the  contraction  of  the  capillaries,  and  consequently  of 
the  organs  themselves  as  wholes  for  the  expulsion  of  the  fluid. 
For  the  reason  assigned,  these  were  the  most  fatal  cases.  The 
writer  does  not  remember  to  have  seen  an  example  of  the  kind. 


•  The  doctrine  Is— if  a  hollow  organ,  having  an  outlet,  net  inordinately  and 
violently,  us  It  is  certain  to  do  when  suddenly  ovcr-dUteiided,  the  sphincter  will 
not  only  not  relax  but  hold  the  more  tightly,  and  nbsoluu^ly  resist  the  passage  of 
the  contents,  and  retention  of  urine,  as  in  the  case  of  the  urinar)'  bladder.  Is  the 
consequonco— so  also  is  th«  retention  of  bile,  In  the  case  under  conttderation. 


sistance 

moving 

n  conse- 

ns,  a  re- 

r  no  less 

nnot  anil 

e  duode- 

ntestinea, 

progress 

He  liver  ? 

ce  of  the 

riters,  and 

olera,  the 

rged  with 

that  fluid 

ppearance, 

a,  is  by  no 

;ion8,  even 

)ccur9  only 

\,  the  inter- 

tnpty.     Our 

recorded  in 
the  stomach 
be  emptying 
ainly  by  the 
iffort  on  the 
1  power  had 
sequently  of 
of  the  fluid, 
cases.  The 
the  kind. 


lordlnntely  and 
3  sphincter  will 
t  the  passage  of 
y  bladder,  is  the 
inslderatloa. 


CHOLERA,  CONSlbEHED  AND  EXPLAINED. 


25 


11.  Manner  of  Evacuation. — In  manner,  the  puking  and 
purging  were  unlike  that  exhibited  in  any  other  disease,  if  we 
except  Cholera  Infantum.  The  matter  is  ejected  from  the  mouth 
as  with  a  pump,  and  from  the  anus  as  by  a  syringe — in  both  instances 
it  would  seem  to  be  'accomplished  by  the  exclusive  efforts  of  the 
stomach  and  rectum,  without  calling  into  requisition  the  muscular 
apparatus  ordinarily  associated  with  these  operations,  and  conse- 
quently in  many  instances  without  much  apparent  uneasiness,  and 
certainly  without  that  pain  and  suffering  which  occur,  when  parts 
belonging  to  animal  life  are  brought  into  action,  as  in  severe 
vomiting  and  purging  from  other  causes.      -.  ; 

12.  Stage  of  Excitement  and  JVature  of  the  Diaeate. — ^From  a 
consideration  of  the  predisposing  and  exciting  .causes  of  Cholera, 
the  conclusion  was  drawn  tliat  they  produced  a  certain  degree  of 
contraction  of  the  capillaries  throughout  the  system,  but  (^specially 
in  those  portions  which  appertain  to  animal  life,  and  r.at  this  con- 
traction, i.  e.  the  predisposition,  might  exist  in  a  greater  or  less  de- 
gree, and  fbr  a  longer  or  shorter  time,  without  the  accession  of  the 
diseasci)  which  usually  followed  the  appkcation  of  some  strongly 
exciting  cause,  or  by  the  accCkmulated  or  concentrated  energy  of 
the.predisposing  causes,  which  it  was  hinted  might  in  roality  con- 
stitute the  specific  cause ; — and  moreover  that  unless  the  pores, 
connected  with  the  aforementioned  capillaries  opening  into  the 
alimentary  canal,  relaxed,  the  phenomena  of  Cholera  would  not 
present  themselves,  and  we  no^  add  that  not  unfrequently 
diarrhoea' (a  consequence  and  proof  of  the  relaxation  of  the  pores) 
of  a  premonitory  character,  in  almost  every  case^preceded  the 
attack  of  the  iMsease  proper,  and  that  this  premonitory  diarrhoea, 
although  it  greatly  increased  the  predisposition  and  danger  too,  by 
emptying  the  vessels,  was  not  characteristir'.-  so  long  as  mucous  or 
fcecal  matters  only  were  dischargedi  but  inabu^.Iy  became  so  when 
the  discharges  began  to  be  watery ;  indicating  that  they  (the 
discharges)  were  from  capillary  vessels  exclusively  appropriated 
to  the  circulation  of  the  serous  and  colorless  portions  of  he  blood. 
On  further  examination,  we  find  that  the  analogy  betwee  a  the  pre- 
disposing and  exciting  causes  of  Cholera,  and  of  febrile  diseases, 
is  very  striking,  and  goes  far  to  prove  that  the  former  is 'also  a 
febrile  disease,  although  it  does  not  often  exhibit  the  phenomena 

2 


i  I 


t 

- 

« 

V. 

♦ 

-,^ 

1   . 

1 

- 

1 

•< 

r 

no 


CHOLERA,   CONSIDEilED   AND  EXPLAINED. 


Will 


which  usually    characterize    that    class    of  disease%— indeed  the 
resemblance  is  so  strong  as  to  challenge  the  conviction  that  it 

.  legitimately  belongs  to  the  same  family,  yet  it  must  be  admitted 
that  in  nearly  all  cases  of  pure  Cholera,  so  considered  and  termed, 
the  stage  of  febrile  excitement  never  appears. 

How  shall  we  account  for  and  explain  away  this  seeming  para- 
dox ? 

In  VU  diseases  of  a  febrile  stamp,  commencing  with  i:hills, 
whether  infectious,  as  small-pox,  measles,  &c.,  or  non-infectious, 
as  intermittent,  remittent,  and  other  fevers,  the  rigor  depends  on 
the  contraction  of  the  capillaries,  and  the  succeeding  hot  fit  on  ths 
relaxation  of  those  vessels,  spontaneously  or  artificially  induced, 
which  follows  the  chill  or  rigor,  during  which  the  pores  do  not 
relax,  nor  indeed  do  they  during  the  hot  fit,  and  not  until  the  heart 
becomes  fatigued  with  its  own  exertipn  and'  acts  with  diminished 
energy,  when  we  have  the  sweating  stage.  But  in  Cholera,  while 
the  capillary  contraction  is  universal  and  intense,  the  pores  loo](ing 
into  the  intestinal  canal  do  relax,  open,  and  allow  the  watery  por- 
tions of  the  blood  to  pass  in  ten  thousand  streams,  by  which  the 
system  is  drained ;  and  the  capillaries,  exhausted  of  their  contents, 
cannot  relax,  but  are  actually  compelled,  by  a  law  which  obtains 
in  the  vascular  system,  to  continue  contracting  more  and  more  in 

''  order  to  keep  in  contact  with  whatever  fluids  remain.  Henca  the 
inability  of  the  capillaries,  in  most  cases  of  Cholera,  to  relax  spon- 
taneously, and  also  our  inability  to  induce  them  to  do  so  by  artificial 
means,  thevefote  the  febrile  excitement  does  not  take  place,*  but 
as  if  to  establish  the  doctrine  of  identity  of  this  disease  with  fever, 
yielding  of  the  capillaries  does  sometimes  take  place,  and  a  series  of 
consecutive  symptoms  follow: — the  disease  then  assumes  the  type 
of  conges;  °  e  fever,  which  is  not  uafrequently  fatal,  although  some- 

*The  ca^tllatieg,  like  o<her  hollow  organs,  have  no  positive  povver  of  relaxing 
and  distending  theiuselves— they  can  only  forego  jheir  resistance  and  allow  them- 
selves to  be  distended ;  but  in  Cholera,  for  the  reason  assigned  in  the  text,  there  is 
no  distending  force  acting  from  within,  therefore  the  constriction  remains,  and 
interrupts  or  stops  entirely  the  functions  of  life :  here  again  the  analogy  holds, 
for  in  some  attacks  of  intermittent  fever,  in  which  the  vessels  nover  relax, 
the  patfent'dies  during  the  cold  fit— but  in  these  as  in  all  others,  diuriug  the  cold 
stage  of  fever,  the  capillaries  ore  so  contracted  that  the  fluids  cannot  reach  the 
pores,  iind  there  is  therefore  no  discharge,  j  ^ 


CHOLERA,  CONSIDERBD   AND  BXPLAIPBD. 


27 


edthe 
that  it 
imittcd 
ermed, 

g  para- 

fhills, 

tectious, 

iend9  oa 

it  on  the 

induced, 

3  do  not 

the  heart 

minished 

ra,  while 

s  looking 

itery  por- 

rhich  the 

contents, 

Ih  obtains 

i  more  in 

Jence  the 

elax  spon- 

y  artificial 

)lace,*  but 

yith  fever, 

a  series  of 

!S  the  type 

lUgh  some- 

r  of  relaxing 
1  allow  them- 
text,  there  is 
remains,  and 
lalogy  holite, 
ndver  relax, 
iriug  the  cold 
ot  reach  the 


times  cared.  Indeed,  Vre  do  not  recollect  any  instance  of  recovery 
from  what  could  be  called  Cholera  proper,  except  through  this 
stage'of  excitement.  Such  cases  were  considered  of  a  milder  grade. 
It  is  worthy  of  notice  that  this  relaxation  and  egccitemsnt,  if  we 
may  be  allowed  the  expression  not  unfrequently  occur  after  death 
(the  efnision  through  the  pores  having  ceased  with,  and  often  prior 
to  that  event),  which  accounts  for  ^he  return  of  color  and  heat  on 
the  surface,  and  the  muscular  contractions  also,  which  are  more 
evanescent  than  the  heat  and  color.  These  pot'  tortem  contrac- 
tions are  not  produced,  like  the  ante  mortem  (..u<nps  and  spasms, 
by  contractions  in  any  particular  muscle  or  part  of  a  muscle — they 
are  not  indeed  truly  spasmodic^  but  resemble  the  contractions 
which  occur  in  epilepsy  or  convulsions,  in  which  the  whole  mus- 
cular apparatus  connected  with  a  limb  is  called  into  action,  and  by 
which  the  member,  as  a  whole,  is  moved.  They  are  not  unlike  the 
movements  excited  by  the  galvanic  battery.  The  ante  mortem 
cramps  and  spasms  ai-ise  from  the  contraction  of  the  capillaries  of 
the  muscles,  occasioned  by  the  withdrawal  of  their  fluid  contents, 
while  the  post  mortem  movements  exhibited  in  the  defunct  are 
caused  by  the  (Contraction  of  the  capillaries,  excited  by  the  inflow- 
ing of  blood,  their  natural  stimulus,*  which  is  admitted  in  conse- 
quence of  the  spontaneous  relaxation  which  succeeded  to  the  death 
struggle.  The  withdrawal  of  a  portion  of  the  principle  of  vitality 
(the  vis  vita)  which  belongs  to,  or  rather  sustains  animal  life, 
leaves  the  capillary  vessels  free  to  relax,  and  suffer  themselves  to 
be  distended — hence  the  flush,  returning  warmth,  and  also  the 
motions  of  which  we  have  spoken.  If  now  this  distension  could 
be  kept  up  by  the  transfusion  of  blood,  or  any  substitute  capable  of 


*  The  arterial  blood  disteiiidlng  the  mnicular  capillaries,  is  the  primeval  stimu- 
los  which  excites  the  muscles  to  action.  In  the  foetal  slate,  the  muscles  of  loco- 
motion begin  to  contruct  as  soon  as  red  blood  Ih  admitted  into  their  vessels,  and 
as  these  multiply  and  enlarge,  the  movements  of  the  limbs  become  stronger  and 
stronger,  and  nt  length  constitute  the  epoch  in  fietal  life  termed  quickening— 
prior  to  which,  however,  a  sense  of  motion,  illce  that  of  worms  quiggling  and 
nestling  ajmut  in  the  womb,.is  almost  always  perceived  by  the  mother,  and  is  one 
of  the  most  concliuive  and  certain  early  signs  of  pregnancy  previous  to,  quicken- 
ing. Feeling  these  internal  movements,  women  sometimes  thiuk  they  are 
troubled  with  worms  when  they  are  not.  .  -    ...^.. .    .v.. 


i:   :• 


CHOtERA,  CONSIDEBED  AND   EXPLAINED* 


*.ii* 


sustaining  theae  movementa,  might  not  resuscitation  in  some  instan* 
ces  at  least  follow  ? 

13.  Collapse.— To  this  term,  "  collapse,"  we  object.  Taken  in 
its  strict  legitimate  or  radical  meaning,  there  seem  to  be  no  pheno- 
mena in  Cholera  which  warrant  its  use.  Let  us  see.  It  is 
derived,  as  all  know,  from  eollabor,  "  to  fall  together  as  the  sides 
of  a  vessel,"  indicating  that  they  do  so  because  they  have  not 
the  ability  to  keep  asunder ;  but  in  Tholiera  the  sides  of  the  capil- 
laries are  brought  together,  not  froj*:  want  of  power,  but  with  resist- 
less energy — by  that  very  contractile  effort  which  is  one  of  the 
essential  ingredients^ne  of  the  pathognomonic  symptoms  of  the 
disease,  a  condition  without  which  the  disease  could  not  exist.  We 
therefore  suggest  that  the  term  is  not  correct  in  its  application,  and 
liable  to  lead  to  errors  in  practice,*      iy   :  •'t:(...^^•■;  ,  'U  *;  t '«  '^-'"t  * 


:V. 


•  »;  J. 


/ 


THE  PROXIMATE  CAUSE,     '.^ji^.v -v-o.T^rM 


This  we  conceive  to  be  a  general  or  universal  contraction  of  the' 
capillaries,  and  particularly  those  which  circulate  the  serous  and 
colorless  constituents  of  the  blood,  with  a  relaxation  of  the  pores 
belonging  to  the  same  class  of  capillaries,  which  open  into  the  ali- 
mentary canal.  This  contraction  of  the  capillaries  forces  the  blood 
inwards,  and  produces  a  cougested  state  of  the  vessels  of  the  abdo- 
minal viscera,  the  colorless  portions  of  which,  however,  pass  into 
the  capillaries  witkoutdistending  them  so  suddenly  and  violently  as 
to  induce  their  pores  or  sphincters  to  resist,  and  refuse  to  let  them 
(the  serous  portions)  pass,  which  accounts  for  the  immense  quan- 
tity of  aqueous  matter  discharged  from  the  stomach  and  bowels. 
This  contraction  of  the  capillaries  and  relaxation  of  the  pores  con- 
stitute the  proximate  cause,  or,  in  other  words,  that  pheno- 
menon in  (ht  body  most  immediately  preceding  the  state  which 
we  call  Cholera,  and  without  which  that  disease  is  not  known  to 


exist. 


all  ymi 


*  Under  certain  clreuinttances  the  sides  of  th»  itomalta,  and  the  veins  espe< 
cially,  after  death  fail  together ;  but  the  capiilaries  never  do  that,  either  in 
Cholera  or  any  other  disease. 


choleha,  considered  and  explained. 


J)9 


•'.r- 


INDICATIONS  OF  CURE. 


.!.'{;.     ii, 


These,  whether  preventive  or  curative,  are  deduced  from  the 
proximate,  predisposing,  and  exciting  causes.  If  the  latter  are 
removed  the  disease  does  not  occur,  neither  does  it  supervene  if 
the  contraction  of  the  capillaries  or  the  relaxation  of  the  pores  is 
prevented.  If  the  capillaries  are  made  to  relax  and  the  pores  to 
contract,  the  disease  is  either  certainly  cured,  or  passes  into  the' 
congestive  form,  in  which  case  it  is  the  more  manageable.  In  a 
former  part  of  this  paper  it  has  been  shown  that  all  the  predispr'^- 
ing  and  exciting  causes  of  Cholera  tend  to  produce,  and  actually 
do  produce,  a  contracted  state  of  the  capillaries,  which,  we  said, 
constitutes  the  predisposition. 

These  (the  predisposing  and  exciting  causes)  should,  therefore, 
be  all  avoided,  or  ren>oved,  if  practicable,  and  their  effects,  t.  e.  the 
contraction  of  the  capillaries,  obviated.  During  the  prevalence  of 
Cholera  persons  should  be  particularly  careful  to  avoid  exposure  to 
coldi  which  exerts  a  powerful  agency  in  producing  that  contraction, 
and  to  keep  themselves  warmly  clad,  rather  m«re  so  than  usual,  or 
than  may  seem  absolutely  necessary,  the  propriety  of  which  will 
be  obvious  from  the  certain  tendency  of  warmth  to  keep  the 
cutaneous  capillaries  relaxed  and  distended.  During  the  night 
care  and  caution  should  be  taken  to  prevent  exposure  to  cold  or  . 
damp;  "by  night  or  noon"  they  should  be  most  scrupulously 
guarded  against.  It  is  not  necessary  to  particularize  in  this  place, 
as  the  exciting  and  predisposing  causes  have  been  considered  at 
great  'ength,  to  which  the  reader  is  referred.* 

Various  methods  of  treatment  have  been  recommended,  adopted, 
and  praised,  among  which  is  blood-letting,  calomel  in  large — enor- 
mous doses,  calomel  and  opium  in  doses  small  or  liberal;  tart, 
emetic  ;  stimulants, — a^i  large  quantities  of  brandy,  ice,  Jic.  So  far 
as  the  author's  observation  goes,  when  th'e  disease  has  fairly  set  in 
one  method  of  treatment  is  about  as  good  as  another,  and  none  of 


h 


( 


*  Radishes,  cucnmbers,  pease,  which  we  observed  prouaced  Cholera  in  1833, 
mora  certainly  than  any  other  vegetable  dish  ;  all  unripe  fruit,  decaying  vege- 
tables, &c.,  oysters,  lobsters,  clams,  most  fresh  fish,  veal,  tec,  should  be  placed 
in  (he  same  catesory— improper  food.  ■    , 


I 


-r       » 


;  i 


m 


CHOLERA,  CONSIDERED   AND  EXPLAINED. 


them  of  much  value,  except  bo  far  as  they  tend  to  keep  up  hope 
and  confidence  in  the  patient  *  Others  were,  however,  of  a  differ- 
ent opinion,  and  have  reported  considerable  success  to  have  followed 
their  respective  modes  of  treatment.  We  shall,  therefore,  examine 
briefly  into  the  grounds  of  that  success. 

Remembering  that  relaxation  of  the  capillaries,  on  the  one  hand, 
and  stopping  the  e<i\islon  of  fluids  through  the  pores,  on  the  other, 
-ate  ine  objects  to  be  aimed  at,  let  us  inquire  in  what  way  they  are 
to  be  accomplished  by  blood-letting. 


ii 


1* 


.  I,  i  i. 


,     '  •     Blood-letting.  >?  ';>       > ''     -  ^  ■■ 

During  the  cold  fit  of  an  ague  the  capillaries  are  so  contracted 
that  the  fluids  which  circulate  in  them  cannot  reach  the  pores; 
hence  the  dry  skin,  dryness  of  the  throat,  and  consequently  thirst, 
paucity  of  urine,  and  a'usence  of  all  tendency  to  discharges  from  the 
alimentary  canal.  If  this  condition  of  things  could  be  produced  in 
Cholera,  the  same  r^ult  would  certainly  follow  ;  and  I  doubt  not 
it  may  be  sometimes  brought  about  in  that  disease  by  blood-letting,^ 
which,  by  promptly  emptying  still  more  the  blood-vessels,  causes  in 
them  a  more  vigorous  and  sudden  contraction,  which  prevents  the 
fluids  from  reaching  the  pores ;  and  furthermore  this  sudden  addi- 
tional contraction  may  be  all  that  is  wanting  in  order  tb  secure  the 
spontaneous  relaxation  which  in  common,  ordinary  cases  so  readily 
follows  the  extreme  contraction  of  the  capillaries  from  other 
causes.  Governed'by  this  theory,  the  writer  was  led  to  adopt  the 
practice  of  blood-letting  in  the  cold  fit  of  intermittent  fever,  as 
recommended  by  Mackintosh,  and  in  every  case  with  entire  satis- 
faction. He  has  biten  seen  the  fit  stopped  before  half  a  pint  of 
blood  was-drawn,  and  the  whole  disease  cured,  as  it  were,  from 
that  moment,  subsequent  fits  being  prevented  by  proper  treatment. 
His  reasoning  was,  that,  if  the  capillarries  could  be  made  to  contract 


*  It  is  said  that  in  1833  it  was  announced  in  Quel)ec  or  Montreal  tiiat  a  cer- 
tain individual,  not  a  doctor,  had  an  infillibie  remedy  for  Cholera,— that  he 
administered  it  with  the  mait  wonderful  success, — until  it  was  found  out  t^  be 
nothing  but  Anely  pulverised  charcOal  and  milk.  The  confident,  the  certain 
expectation  of  being  cured  by  it  did  more  for  the  patiert  than  the  remedy. 


CHOLERA,  CONSIDERED  AND   EXPLAINED. 


31 


only  a  little  more,  the  period  of  their  utmost  contraction,  which 
ordinarily  took  place  immediateiy  prior  to  the  commencement  of 
the  hot  fit,  would  be  anticipated,  and  the  spontaneous  relaxation 
immediately  follow,  and  such  was  the  uniform  result.  On  this 
principle,  benefit  from  venesection  may  be  expected.  During  the 
prevalence  of  Cholera  in  1832,  not  having  sufficient  confidence  in 
the  principle  as  applied  to  that  disease,  the  practice  was  not  fully 
put  to  the  test.  In  the  few  cases  in  which  it  was  tried  the  result 
was  in  its  favor ,~-80  much  so  as  to  incline  the  writer  to  think  favor- 
ably of  it. 


•■>.•'!-.' 


'■J'.'   '•■.!.. J 


Large  Doses  of  Calomel. 


Some  practitioners  gave  calomel  in^drachm  doses  and  some  by  the 
half  ounce,  and  as' they  say,  with  advarttage.  If  beneficial,  it  must 
have  been  because  the  calomel  in  large  quantities  and  too  heavy  to 
be  ejected,  came  in  contact  with  the  pores  opening  into  the  stomach 
and  bowels,  and  stimulated  them  to  contract  and  stop  further  efi'u- 
sion,  upon  what  principle  I  cannot  tell.  The  solution  of  tart,  emetic, 
which  in  the  hands  of  some  practitioners  is  said  to  have  been 
followed  with  considerable  success,  acts  by  causing  a  contraction  of 
the  capillaries  of  the  stomach  (its  true  physical  efiect),  which  was 
sufficient  to  prevent -their  contehts  from,  reaching  the  pores,  and 
also  that  additional  contraction  spoken  of  under  the  head  of  blood- 
letting. Which  is  foUovved  by  spontaneous  relaxation.     ^^  <^'a<,^.  (,-,__ 


Opium. 


If  we  could  get  narcotics  into  the  system  in  sufficient  quantity 
to  prevent  the  capillaries  feeling  the  impression  made  on  them  by 
causes  which  induce  their  contraction,  or  woul^  incline  them  (the 
capillaries)  to  forego  their  contraction,  they  would  relax— perhaps 
so  rapidly  as  to  becomt^  over-distended,  when  the  pores  would 
resist  and  stop  the  further  escape  of  serum,  &c.  When  opium 
operates  in  this  way,  it  is  very  efficacious  in  arresting  internal 
hsmorrb;iges,  especially  from  the  uterus.  I  have  often  seen  opium 
in  small  doses,  as  a  single  grain,  beneficial  when  given  immediately 
after  each  ejection  from  the  stomach  or  rectum. 


82 


CHOLERJi,  CONSIDERED   AND  EXPLAINED. 


ill 


CURABILtTY  OF  CHOLERA. 


■J  . 


n  ■ 

■  f, 

I:' 


'.I        It  1 


fi     iiiii' 
'Hi-. 


The  principal  reason  why  Cholera,  when  once  fairly  set  in,  is  ho 
unmanageable  or  incurable  is,  that  all  remedial  agents  introduced 
into  the  stomach  and  bowels  are  prevented  by  the  aqueous  maiter, 
and  its  frequent  ejection,  from  coming  in  contact  or  remaining  long 
enough  in  juxta-position  with  their  inner  coats  to  have  any  medici- 
nal effect  whatever. 

If  this  be  a  correct  view,  prevention  is  almost  our  only  hope ; 
and  it  is  good  to  know  that  this  may  be  accomplished  by  the  removal 
or  avoidance  of  the  predisposing  and  exciting  causes,  or  by  attend- 
ing to  the  premonitory  symptoms,  particularly  the  diarrhoea,  which 
in  every  case  that  came  under  the  writer*s  notice,  preceded  the 
accession  of  the  disease  proper,  and  which  according  to  h)s  expe- 
rience was  always  under  the  control  of  medicine. 

In  Cholera,  as  in  diarrhcea  and  dysentery,  there  are  three  indica- 
tions. 1.  Constringe  the  pores.  2.  Relax  the  Capillaries.  3.  Keep 
the  patient  perfectly  quiet.  ^ 

In  the  diarrhoeal  stage,  the  writer  found  the  acetate  of  lead  and 
opium  quite  adequate  to  the  fultilment  of  the  first  and  second  indi- 
cations. His  method  was  to  give  the  former  in  unc  and  a  half  or 
two  grain  doses,  with  two-thirds  of  a  grain,  or  a  whole  grain,  of  the 
latter  after  every  discharge,  or  as  frequently  as  the  exigencies  of  the 
oise  demanded.    A  single  dose  often  answered  the  purpose.*    Calo- 

*  Having  employed  the  acetate  ot  lead  as  an  internal  remedy  more  llian  any 
otiier  praetltloner  within  tlie  circle  of  his  acquaintance,  the  writer  feels  it  to  be 
his  duty  to  add  a  few  observations  la  regard  to  its  value  and  safely  in  common 
diarrhcea  and  dysentery.  Uis  practice  in  thoee  couiplainis,  and  particularly  the 
inttet  If  severe,  Is  to  confine  the  patient  absolutely  to  the  bed  and  In  the  reciimlient 
posture,  from  which  he  should  not  depart  even  toe  vacuole  the  bnwiilsor  bladder. 
If  allowed  to  sit  on  the  stool,  as  Is  usunlly  done,  the  action  of  the  glutei  muscles, 
through  the  fascia  connected  with  the  sphincter  nn^  muscle,  nnd  also  the  perinetn 
fascia,  which  every  anatomist  will  understand,  tends  to  relax  and  open  the  pas- 
sage, so  that  while  it  facilitates  the  operation,  the  very  thing  not  desired,  it  also 
favors  the  descent  of  tlie  intestine,  and  If  persisted  in  often  produces  prolapsus. 
When  the  ptitieni  is  not  allowed  to  have  a  passage,  except  In  the' recumbent 
posture,  he  finds  more  difiiculty  in  accomplishing  It,  and  is,  therefore,  more 
willing  to  resist  calls  to  evacuate,  in  which  he  should  be  ttroogly  urged  to  persc- 


are, 

fcca 

havll 

Inqii 

fallil 

mati 

ezisl 

cans 

thai 

ciplj 

con  I 


'■^^^s^mit^ 


pt-S; 


mn 


CHOLERA,  CONSIDERED   AND   EXPLAINED. 


:)3 


mel,  ia  doses  of  ten  or  fifteen  grains,  with  three  or  four  of  opium, 
is  not  unfreqiiently  prescribed  for  the  purpose  of  proinotint;  the , 

Tere.  If  there  ts  nauiea,  and  g<jod  reaetin  tu  believe  ttiit  it  is  cauied  l>y  any 
oflbntiye  matter  in  the  •  )macii,  It  should  be  removed  by  an  emetic  o(  ipeeac  apd 
sulphate  of  aine.  Eachewing  all  cathartic  medicine,  I  begin  with  the  acetate  of 
lead  and  opluni.  If  the  .disease  is  severe  the  first  dose  should  consist  of  two  or 
three  grains  of  opium,  and  four  or  six  of  the  acetate,  after  which  the  subsequent 
doses  may  be  regulated,  as  to  quantity  and  frequency,  by  the  exigencies  of  the 
case ;  but  1  have  invariably  found  It  best  to  malte  a  strong  and  decided  Impression 
at  first.  If  the  primary  dose,  so  far  as  the  narcotic  Is  concerned,  ts  larger  than 
the  case  actually  demands— no  matter— the  system  will  be  the  more  amenable 
to  subsequent  doses,  which  may  therefore  be  smaller.  By  adopting  this  methttd, 
the  leaa  medicine  on  the  whole  will  be  required,  and  the  disease  moro  promptly 
and  certainly  cured.  Boole  practitioners  are  in  the  habit  of  giving  calomel  and 
opium  in  dysentery.  In  my  opinion,  all  the  good  that  ii  done  by  that  combina- 
tion is  accomplished  by  the  opium,  while  I  would  not  be  answerable  for  the 
mischief  done  by  its  adjunct.  Why  give  calomel  1  We  are  told  th^t  it  is  to 
correct  the  secretions,  and  particularly  those  of  (he  liver.  In  all  cases  of  fever 
as  well  ae  dysentery.  In  which  the  secretions  are  morbid,  the  acetate  of  lead  with 
opium  is  a  better  medicine  for  effecting  a  change  in  them  than  calomel,  or  in- 
deed apy  of  the  preparations  of  mercury.  The  diarrhoea  and  bowel  affections 
which  so  often  make  their  appearance  in  typhus  and  typhoid  fevers,  and  give 
both  the  practitioner  and  patient  so  much  trouble,  and  are  so  dangerous  to  the 
latter,  should  be  met  at  tHl  very  threshold— not  with  calomel— or  cathartics,  but 
w\jjk  the  above-mentioned  remedies,  in  snfflcient  doses  effectually  to  control 
them,  nalhartlcs,  and  particularly  calomel,  should  be  most  scrupulously  avoided. 
Deprecating  the  approach  of  these  untoward  symptoms,  i  have  not  unfrequently 
let  patlenU  with  typhus  fever  go  five,  six,  and  sometimes  eight  days,  without 
imy  evacuation  ft-om  the  bowels,  and  never  had  cause  to  regret  It.  In  such  cases 
the  physician  should  ^Iways  have  the  sagacity  to  discover  when  a  Idxatlve  is  re- 
quired. With  a  little  educating  the  nasal  organ  will  give  the  hint,  ana  generally 
"emell  out"  the  necessity  for  opening  medicine.  In  dysentery,  physicians 
are,  I  know,  much  in  the  habit  of  giving  cathartics  to  bring  away  the  lumps  of 
faecal  matter,  technically  termed  scybain ;  but,  Jn  the  early  part  of  my  practice, 
having  great  curiosity  to  see  these  offdnding  matters,  I  instituted  a  rigid  course  of 
inquiry  and  observation  in  order  to  detect  them ;  and,  after  a  considerable  time, 
falling  to  do  su,  came  to  the  conotusion  that  there  must  be  some  mistake  In  this 
matter,  and  that  cathartics  were  not  required  for  the  removal  of  what  did  not 
exist,  and  of  course  left  off  ordering  them  in  that  complaint,  and  have  had  no 
cause  to  regret  the  omission.  The  most  abundant  experience  has  satisfied  me 
that  In  dlarrhosa  and  dysentery  the  bowels  should  be  kept  still,  on  the  same  prin- 
ciple that  5ve  would  keep  an  inflamed  limb  quiet.  Injections,  except  such  as 
contain  anodynes  and  those  very  small,  should  not  be  given.    E^en  the  latter, 

2* 


I 


f 


34 


CHOLKRA,  CONSIDERED  AND  BXFLAINED. 


I 


h 


•ecretion  of  bile,  dec.  If  the  state  of  the  liver  and  gall  bladder  if> 
a«  has  been  described,  we  would  in  candor  ask  how  calomel  or  any 
other  medicine  can  emulge  the  liver.  On  another  account,  we 
think  calomel  in  the  early  stages  altogether  objectionable.  We 
have  no  drog  which  is  more  apt  than  calomel  to  excite  an  excretion 
of  flujds  into  ihe  intestinal  canal— the  very  thing  of  all  otheM  in 
Cholera,  or  in  cases  tending  to  it,  to  be  avoided — ^just  what  should 
be  prevented  or  stopped — why  then  give  calomel  ?  That  this  prac- 
tice has  been  sometimes  successful  is  undeniable;  but  the  success 
we  apprehend  yvas-owing  to  the  opium  and  not  to  the  calomel,  but 
in  spite  of  it ;  the  former  did  good  in  its  own  way,  and  moreover 
obviated  the  bad  effects  of  the  latter.^  The  acetate  of  lead  may  be 
cothbined  with  a  sudorific,  with  great  advantage.* 

To  answer  the  3d  indication,  the  patient  should  go  to  bed  and 
remain  there  warmly  covered,  twenty-four  or  forty-eight  hours, 
after  the  diarrhoea  has  entirely  ceased ;  and  he  who  will  not  do  this, 
should  be  told  in  the  plainest  language  by  his  physician  that  he  will 
not  be  responsible  for  consequences.    Within  the  twenty-four  hours 


i      I 


■-'.I , 


as  a  lenenil  mie,  t&onrjl  b«  omlttwl.  Sndorlfliis  contaiaing  optnm  are  of  great 
imporUnce.  Venavectlon,  cupplog,  leecbiug,  fee,  fee,  ai  demanded  by  tho  exigen- 
cies or  each  Individual  case,  iniut  be  ruanried  to.  ]dnc^|||gei  for  noiulshment  and 
"  <AMtAin^"  tlie  bowels  are  recommended  and  given,  ae  if  tb«  stomach  and 
bowels  were  in  a  condition  to  make  nae  of  food  I  The  digestive  powers  tfon%, 
these  substances  become  nubject  to  chemical  action,  and  therefore  do  nothing  bat 
Oilschief,  by  irritating  surAices  olready  tuo  iryititble.  When  the  power  of  digea- 
tiun  Is  absent,  nutritious  matters  are  uncalled  for.  Liquids  may  be  given  in  small 
quantities  at  9  time.  Astringent  iofusions— the  best  of  which  is  strong  green.tea, . 
sweetened  or  not,  with  or  without  cream— as  best  solu  the  patient's  taste,  may 
be  taken ;  it  Is  often  very  graterul,«nd  may  be  glvea  freely  la  the  morning, 
and  fore  part  of  the  afternoon.  Flannel,  worn  next  the  skin,  is  one  of  the  beat 
preventives  of  dyoentery,  during  the  prevalence  of  which  It  should  not  be  dis- 
pensed w)th  by  the  well  or  by  the  sick.  • 

•»  Opium,  1  ;'•'!«',; L,V-^7tyr 

Ipecac,       >grain8  4.  ,    -  •  '     ' 

M,-    ■;<    -;,  •';'i  .'ii'     II".  ,v      Camphor,  >  '^  _  i^-s  ••■tnJjtilRHiiiU 

Acet.  of  lead,  3ss. 
Mix  intimately  and  divide  into  ^  equal  parts.  The  patient  (In  bed)  is  to  take 
one,  and  the  others  in  succession— s^y  one  after  ea«;h  evacoation  from  tlie 
Imwels.  When  the  dlarrhtea  has  stopped,  which  it  will  generally  do  after  the 
administration  of  the  first  powder,  the  pswders  may  be  taken  every  6th  hour,  th* 
acetate  being  left  out.' 


' .  -f 


CHOLERA^  CONSIDERED  AND  EXPLAINED. 


a5« 


dder  i» 

or  any 

nt,  we 

J.    We 

cretion 

hef6  in 
should 

is  prac- 

•uccera 
mel,  but 
nor cover 
I  may  be 

betl  and 
it  hours, 
)t  do  thiH, 
it  he  will 
our  hours 
■  mi^'v 

are  of  sreat 
f  tho  eitgeo- 
Uhment  and 
itofliacb  and 
wweri  uon%, 
I  nothing  bat 
iver  of  digea- 
iven  In  small 
ng  graen.tea, . 
,'•  taite,  may 
be  morning, 
le  of  ibe  best 
Id  not  be  4I«- 

«d)  Is  to  take 
lion  firom  the 

I  do  afler  the 
6th  hour,  the 

II  {5>cin»  nift'm. 


after  the  cessation  of  the  discharges,  a  laxative  of  castor  oil  (the 
best)  or  rhubarb  may  be  directed,  if  deemed  necessary,— the  patient 
keeping  in  bed  a  day  or  two  after  its  operation,  in  order  to  make  the 
cure  certain  and  permanent.  The  recumbent  posture  will  be  of 
great  utility  in  every  case,  and  in  many  the  line  qu&  non  to  a  happy^ 
result,  to  which  the  quietude  and  warmth  of  the  bed  no  doubt  con- 
tribute much. 

When  the  symptoms  peculiar  to  <Cholera  have  become  manifest, 
we  are  much  inclined  to  think  that  the  ti^atment  under  which  the 
patient  is  most  likely  to  recover,  will  be  to  disturb  him  as  little 
as  possible— to  administer  such  things  only  as  seem  to  be  most 
agreeable  and  comforting  to  him.  Pleasing  impressions  induce 
relaxation  of  the  capillaries.  I'o  make  such  appliances  as  are 
calculated  to  have  the  same  effect,  viz.  gentle  friction  under 
the  bed  clothes, — moist  applications,  the  tendency  of  which  is  to 
lower  the  temperature-of  the  body  by  evapv&tion,  should  be  with- 
held; tu  preserve  the  confidence  of  the  patient,  and  especially  his 
hope,  whick  being  a  pleasing  pavsion,  also  tends  to  produce  relaxa- 
tion, it  may  be  well  to  keep  up  the  appearance  of  doing  something, 
without  in  any  degree  interfering  with  his  comfort,  Enemas  should 
not  be  administered.  He  should  not  be  annoyed  in  any  way.  In 
some  cases,  I  think  I  saw  some  benefit  derived  from  administering 
six  or  ten  grains  of  the  acetate  of  lead  dissolved  in  a  table-spoonful 
of  water,  with  ten  or  twenty  drops  of  laudanum,  immediately  after 
each  voniiting. 

From  what  he  witnessed  Juring  the  visitation  of  the  Cholera 
in  1832,  the  writer  is  convincen  that  vastly  t(>o  much  was  done  by 
doctors  and  nurses.  '  They  seemed  to  think  that  this  gigantic  disease, 
this  "  monster  malady,"  could  bo  cured  only  by  main  strength,  and 
therefore  gave  nature  no  chance ;  whereas  the  most  judicious  course 
in  many  cas^s  would  have  been  "  to  stand  stiU  and  let  ftie  patient 
get  well"  if  he  could.  When  we  do  not  know  what  to  do,  wisdom 
dictates  that  we  do  nothi%.  We  do  not  mean  to  insinuate  that 
patients  wouM  have  recovered  if  they  had  been  less  severely  doc- 
tored ;  but  we  do  say  that/many  were  doctored  top  much. 


I ; 


i. 


'-«iic 


i 


!  •  -S. 


.I.v^ 


1?  < 


V:   ■••?'    }", 


>     * 


ii.-'-t 


-*■•.:'=;   , •..><;» 


■■■,„•  ;,vv:-  - 


/., 


.  '   ..  '  ■    ■*■■•  ;■',•'  ,  ■  ■•  ■-  ••.';'-  '    >^i'.4:'i7,  .iT.-^::''  .f/'i>'t 

'      -'-  ;       '     i',-  I'l^  '.    <  .,  ■■    - ,/  i  !:■;  .  >>~u  t  '*'>■'!■.■  K-ii 

■"••■       ■•';•■'.-..''        'v.  .     .:    :  '  ;»^»i  ji';;^!'-.  T-i-    :«  l#v    • 

.;':.''i'';-jif'«-^' €■•'■*?»■ 

*            ■       *     '  -.             •         •        * 

'  '  ■  ■■  '.■'     '■'■'■■.if    t  ■  ■  ■■  ■•;.i  '.''*, :*''i  ',^-->r.:i  r*;^u-;r? -„ 

•'.■')V.    ■       -.>_-».  ..-.  •    :_.;.■   ■.  -.rf   u  ''M*'*'  ^'''■. 

■■■:.■■           .       K  :  •  ■*,•     .•■    .•  M    ;.     ^-;M   s'i-5;4:.h 


\\,--y 


■» :  A;.f\.-ui   •;:  ^-• 


'     I:        * 


,     t 


;  *^'.^"i"*S  APPENDIX, 


Under  existing  circumstances,  cholera  furnishbs  a  subject  which ' 
very  properly  engages  much  ot  the  attention  of  the  medical 
profession,  not  only  in  this  city,  but  probably  throughout  the 
country ;  and  it  is  to  be  confessed  and  regretted  that  the  op'nions  of 
the  faculty  in  regard  to  its  nature  and  mode  of  propagation,  and 
also  its  treatment,  are  far  from  being  accordant  and  settled.  Dis- 
turbing and  deranging  the  business  of  a. whole  community,  and 
c&usin  o3S  of  life  and  property  beyond  calculation — and  hovering, 
as  it  docs,  at  this  time,  over  this  city,  or  actually  (this  paper  was 
written  in  December  last)  prevailing  in  it,  as  some  believe  and 
assert,  its  modf  of"  personal  communicability"  is  a  matter  of  grave 
and  solemn  import,  well  calculated  to  excite  emotions  of  the  deepest 
interest.  In  its  mode  of  communication,  is  it  not  reasonable  to 
suppose  that  it  will  act  in  obedience  to  the  laws  which  govern- 
other  diseases  belonging  to  the  same  class  ?  Is  it  then  contagious  ? 
Is  it  infectious?  The  reader's  attention  is  asked  to  what  will 
be  offered  in  relation  to  these  interrogatories.  So  far  as  the  author 
knows,  the  views  to  be  presented  have  never  been  entertained  by 
any  other  person  ;  he  therefore  solicits  that  they  may  be  considered 
with  candor.'l.  i'-*'.^  Af  i>«-''\«i'>.  9f^i'^h  s^ssej 

(■!  t«aU.rjj«iWf^     '  ^       '       ■     ..  ■ 

fc^itj.t«>!>    ..;i,^ig  CHOLERi  CONTAGIOUS? 

Its  cause,  like  other  epidemics,  is  unknown  to  us,  consequently 
we  can  gather  no  information  from  that  source ;  but  with  its 
phenomena  we  are  aU  familiar,  either  from  reading  or  personal 
observation,  and  by  comparing  them  with  those  which  essentially 
and  invariably  accompany  diseases,  known  and  acknowledged  to  be 


'  stl"      , 

jf^-- 

^^A^^* 

i,<i1l-  >, 

>*: 

■h'r 

n^.5 

isr.t^* 

.,4 

--■;h";,f' 

.fVl-    . 

7  '"^ 

''4 

.vA.t 

■! 

*.■■> 

*  '  ■<.'?^}? 

e 

?J 

:U'« 

rTAfj 

roi 

TS> 

'M*^'.-^ 

'^r. 

i*.1»V>.>. 

r 


\f^ 


38 


APPENDIX. 


.!        ! 


'ft 


contagiou!!  diseases,  we  shall  probably  find  data  sufficient  for  the 
solution  t)f  this  question.  In  order-then  Co  set  up  a  standard,  by 
which  to  try  this  "  monster  malady"  in  this  particular  relation,  we 
must  ascertain  and  determine  what  is  a  contagious  disease. 

In  scarcely  any  instance  is  the  language  of  common  conversation, 
or  even  that  of.  ordinary  professional  parlance,  sufficiently  definite 
and  exact  for  scientific  purposes,  and  this  circumstance,  probably 
more  than  anything  else,  has  been  the  cause  of  so  much  dis- 
crepancy of  opinion  and  angry  discussion  among  medical  men  in 
respect  to  the  contagiousness  of  this  as  well  as  of  other  diseases. 
Even  contagion  and  infection,  familiar  to  the  profession  as  house- 
hold words,  hare  never  yet  b^d  precise  and  definite  meanings 
attached  to  them ;  in  many  instances  they  are  regarded  and  used 
as  synonymous  and  convertible  terms,  hence  the  confusion  and 
uncertai  nty  so  apparent  when  these  topics  are  discussed ;  on  that 
account  we  see  gentlemen,  in  attempting  to  av^'ti  one  error, 
continually  running  into  another.  The  only  -v  /  o<  -"ping  these 
evils  is  to  fix  the  meaning  of  those  terms,  iHiC^  men  we  may 
determine  what  is  a  contagious  or  what  an  infectious  disease. 

Contagion  is  the  transmission  of  a  disease  from  one  person  to 
another  by  contact,  i.e.  through  the  medium  of  the  touch.  Now, 
the  skin  is  the  only  part  of  the  body  designed  by  nature  tu  come 
in  contact  with  surrounding  matters — with  the  material  world ;  it 
is  therefore  the  organ  of  touch,  and  consequently  the  seat  of 
contagious  disease;  it  must  be  so;  for  how  can  one  individual 
come  in  contact  with  another,  so  as  to  communicate  a  disease, 
which  is  communicable  by  contact  only,  except  by  touching  his  - 
skin?  It  must  be  skin  to  skin,  so  that  the  matter  capable  of 
producing  the  disease,  can  pass  from  one  skin  and  fix  itself  on 
another.  This  may  be  termed  communication  by  "  direct  contact ;" 
but  the  disease  -lay  be  contracted,  imparted,  or  communics^*-*;''  by 
wearing  apparel,  or  sleeping  in  sheets  to  which  the  ci, .  ui^^  '-Mr' 
cause  adheres;  in  that  case,  however,  the  cause  comes  'n  i -ci 
with  the  skin  of  the  individual  exposed.  In  both  instancv^  b- 
cause  and  the  subject  may  exist,  but  contact  is  the  nne  qu&  nan  ot 
the  disease. 

We  say,  then,  that  a  contagioue  disease  is  one  which  attacks  the 
skin  ;  is  always  produced  (if  produced  at  all),  in  all  persons,  in  all 


'>» 


TV"  I    ^'    'T^r 


AI>PBNDIX. 


»» 


For  the 
lard,  by 
ion,  we 

Irsation, 

Idefinite 

Irobably 

ich  dis- 

tnen  in 

liseases. 

hcuse- 

aeanings 

nd  used 

sion  and 

on  that 

e  error, 

ng  these 

we  may 

ase. 

person  to 
1.  Now, 
i  tu  come 
world;  it 
e  seat  of 
ndividual 
Bi  disease, 
ching  his  ■ 
apable  of 
itself  on 
contact ;" 
licf -■  •'  by 

"n     ■■  ii"3i 

ancv^    b- 
u&  ncn  ui 

ttacks  the 
ons,  in  all 


climates,  all  seasons,  and  under  ail  circumstances,  by  the  contact 
only  of  the  same,  sing'e^  identical  cause,  which  cause  affects  all 
obnoxious  to  its  influence,  always  in  the  same  way  and  manner,  but 
which  never  contaminates  the  system.  A  disease  which  never 
conferl  on  the  individual  who  has  been  subjected  to  its  influence, 
or  rather,  who  has  once  had  it,  the  slightest  immunity  from  subse- 
quent attacks,  but  which  of  the  two  renders  him  rath»?r  more 
susceptible,  somewhat  in  proportion  to-the  number  of  times  he  has 
been  affected  ;  a  disease  tha^  never  gets  well  of  itself,  and  therefore 
••  has  no  tendency  to  a  spontaneous  cr"e ;"  a  disease  which  "  is 
never  developed  ("pijotaneously,  and  is  not  epidemic  or  endemic;" 
the  cause  being  obviously  insufficient  for  such  results.*  Always 
arising  from  thft'same  cause,  it'is  ever  the  same.  By  way  of  illus- 
tration we  take  scabies  as  an  example — a  complaint  whose 
contagiousness  is  unquestioned  and  unquestionable— with  which  all 
are  familiar,  either  by  pergonal  experience,  or  ftom  personal 
observation,  and  is  therefore  well  suited  to  o<ir  present  purpose. 
The  skin,  as  has  been  observed,  is  the  only  part  of  the  system 
designed  by  nature  to  come  in  contact  with,  or  receive  impressions 
from  surrounding  substances,  and  as  this  affection  can  be  produced 
by  the  contact  only  of  its  own  peculiar  exciting  cause,  it  follows 
that  that  particular  structure  or  organ  is  the  invariable  seat  of  this 
malady,  vvhich  may  extend  over  the  whole  external  surface  of  the 
body,  "  except  the  face,"  but  to  no  other  part.  If  applied  to  the 
inner  surfaces,  as  the  mucous  membranes,  the  cause  would  at  once 
be  destroyed  or  rendered  inert  by  influences  to  which,  under  such 
circumstances,  it  must  be' unavoidably  subjected.  This  distemper 
is,  as  all  know,  caused  by  an  insect,  the  acarus  scabiei,  which, 
coming  in  contact  with  the  cuticle,  penetrates  it,  and  excites 
inflammation  and  intolerable  itching,  and  it  is  acknowledged  and 
admitted  by  modern  pathologists,  that  it  can.  be  produced  in  no 
other  way,  and  by  no  other  cause  ;t  that  it  spreads  to  various 
parts  by  the  insect  being  transferred  to,  and  brought  in  contact 
'With  tiiem  in  divers  ways.  It  "  has  no  tendency  to  a  spontaneous 
cure,"  and  therefore  never  ceases  but  by  the  use  of  remedies ;  it 
never  contaminates  the  system  nor  the  atmosphere,  and  is  not 


*  Contagloui  diieasen  are  Indmd  fbw  In  nurhbai. 
t  This  optoloa  \» not  quite  unh ^-nal. 


'..i 


\\  i 


f 


.  • 
, } 
■  1 


40 


APPENDIX. 


;* 


I'  'i 


epidemic ;  nor  does  it  atTord  the  sufferer  any  exemption  or 
immunity  from  subsequent  attacks. 

vVe  shall  bring  forward  but  one  other  disease  as  illustralive  rf 
our  present  position,  the  porrigo  favosa,  the  contagious  nature  and 
character  of  v/hich  will  not\  be  questioned  or  doubted,  and  is 
therefore  adapted  to  our  purpose.  Unlike  scabies,  porrigo  is  caused 
by  a  vegetable  parasite,  which,  coming  in  contact  with  the  surface, 
fixes  upon  a  spot,  penetrates  the  cuticle,  excites  inflammation, 
itching,  &c.  This  pai^psitic  vegetable  produces  no  otb  ^r  disease, 
nor  is  this  disease  produced  by  any  other  cause,  nor  in  any  other 
way  even  by  this,  but  by  contact.  Like  scabies,  it  spreads  over  the 
surface,  but  is  confined  to  the  skin,  and  therefore  never  contami- 
nates the  system  «r  atmosphere,  has  no  tendency  to  spontaneous 
cure,  and  is  never  cured  but  by  remedies ;  when  once  cured,  it 
affoi-ds  the  patient  no  immunity  from  subsequent  invasions.  Un- 
complicated, it  always  exhibits  the  same  phenomena  in  all  subjects, 
under  all  circumstances,  climes,  and  seasons.  These  two  distem- 
pers furnish  perfect  examples  of  contagious  disease,  (for  which 
purpose  alone  they  have  been  introduced,)  compared  \yith  which 
cholera  has  no  symptoms  in  common. 

Now,  can  we  pronounce  a  disease  which  has  no  analogous 
feature — no  characteristic  symptoms  in  common  with  another,  to 
belong  to  the  same  class — to  be  of  the  same  Species  ?  If  the  views 
we  have  taken  of  contagion  and  of  contagious  diseases  be  correct, 
are  we — can  we  be  justified  in  saying  that  cholera  is  contagious  .' 
Besides,  it  is  acknowledged  that  persons  may  have  cholera  who 
have  never  beegi  in  contact,  or  even  within  many  miles  of  any  one 
afflicted  with  that  malady,  or  anything  impregnated  by  euianations 
from  the  sick ;  facts  which,  it  would  seem,  furnish  a  most  conclusive 
and  unanswerable  argument  against  iU*  being  contagious,  in  the 
strict  and  legitimate  sense- of  the  term.     Is  not  utter  impossibility 


implied .' 


iDlieu 


II.— IS  CHOLERA  INFECTIOUS? 


':■<  I'.i  m^t!-'  ;':■.■  ■' 

,  i     •  c-    ' 


Coming  to  another  class  of  diseases,  we  find  it  necessary  to  settl* 
with  definite  and  technical  precision,  the  meaning  of  terms,      ' 


/  • 


T 


APPENDDl. 


4t 


*  Infection  Is  from  infteio,  to  stain  or  dye.  It  has  the  radical  sense  of  in  and 
/acta,— to  make  In.  "To  Infect,  lata  thrast  in."  The  infecting  cause  must  get 
into  the  system,  or  it  cannot  contaminate  it.  "  During  the  scarcity  of  capper  coin 
before  the  establishment  of  the  mint,  the  common  council  of  the  city  of  New  York 
emitted  little  bills  of  credit,  of  one,  two,  and  three  |ience,  made  of  thick  bibulous 
pnper.  They  became  dirty,  worn,  and  impregnated' with  everything  they  could 
wipe  fVom  cuman  Angers,"  in  which  condition  "  they  were  carried  to  the  City 
Treasurer's odlce  to  be  exchanged  for  new  ones.  The  Treasurer  threw  them  into 
a  close  desk.  This  collection  was  made  during  the  hot  weather  in  summer.  After 
many  weeks  the^ Treasurer  opened  the  box,  und  began  to  unfold  and  unroll  the 
dirty  bill.'i.  Jl  di$afretabU  and  noxious  vapor  proceeded  from  them,  wkieh  poi- 
soned him,  und  nearlti  deprived  him  of  Itfe."  This  was  an  example  of  infection. 
The  noxious  vapor  which  poisoned  the  Treuuror  was  taken  up  and  carried  Into 
the  system  by  the  pulmonary  abt..rbenU. 


)l 


is;^  fii 


We  define  infection*  to  be  the  communication  of  a  disease  by  the 
introduction  of  a  virus  generated  in  the  living  body,  which  contami< 
nates  the  nystem  itito  which  it  is  introduced  and  received,  and 
causes  the  phenomena  of  that  disease  to  appear,  and,  moreover,  a 
matter  identical  with  the  virus  introduced ;  accordingly,  it  is  quite 
immaterial  how  this  poison  or  virus  gets  into  the  system.  We  pro- 
ceed, then,  to  characterize  an  infectious  disease  to  be  one  which 
arises  from  a  substance  received  into  the  body,  which,  by  contami- 
nation in  a  peculiar  manner,  produces  in  every  stage  a  series  of 
analogous  consecutive  morbid  actions,  which  are  the  same  in  all  the 
corresponding  stages ;  the  product  of  which  is  a  virus  identical  with 
the  substance  originally  received,  and  which,  of  course,  is  capable 
of  exciting  the  same  disease,  or  series  of  morbid  actions  and  phe- 
nomena, in  other  individuals, — a  disease  which,  unlike  those  pro- 
ceeding from  contagion,  "  has  a  tendency  to  a  spontaneous  cure," 
and  also  affords  immunity  from  subsequent  attacks.  To  this,  how- 
ever, there  are  numerous  exceptions  ;  enough,  perhaps,  to  warrant 
the  division  of  this  claS's  of  diseases  into  two  or  more  species,  but 
this,  although  a  matter  of  gr  >.!:  scientific  interest,  comes  not  within 
the  scope  of  our  present  purpose. 

We  shall  take,  for  examples  and  illustrations,  three  diseases,  with 
which  all  are  familiar,  and  about  whose  characters  for  *<  personal 
communicability,"  there'is  nothing  equivocal,  ambiguous,  doubtful, 
ur  uncertain,  viz.  small-pox,  measles,  and  cow-pox.  We  have 
selected  them  for  one  other  reason,— they  are  held  to  be  contagious  ; 


in 


h  , 


4 


42 


APPENDIX. 


i)        ' 


1 1       »>■ 


the  tvfo  former  are  also  consideted  tob^  infectious  as  well  as  conta- 
gious, while  the  latter  (cow-pox)  is  pronounced  "  only  contagious, 
not  infectious"  by  high  authority  in  these  matters  ;•  a  proof  of  the 
very  loose  manner  in  which  professional  men  have  been  in  the  habit 
of  thinking  and  writing  on  these  topics. 

But  are  these  diseases  contagious ?  1.  Is  small-pox  contagions? 
Does  its  virus  produce  the  disease  by  simple  contact,  direct  or  indi- 
rect ?  We  will  not  demand  of  our  friends,  the  contagionista,  a 
categorical  answer  to  this  last  interrogatory ;  but  say  what  they 
say,  that  there  are  three  ways  or  modes  of  communicating  the 
disease  with  tolerable  certainty,  and  also  another,  of  very  questioA- 
able  character,  which  we  will  proceed  to  examine. 

1.  Small-pox  may  be  communicated  to  the  foetus  in  utero,  and 
that  too  when  the  mother,  having  previously  had  the  disease,  re- 
mains perfectly  free  from  every  symptom  of  that  distemper.  In 
this  case,  the  varioloas  matter  is  received  into  the  maternal  system, 
and  transmitted  through  it  to  the  foetus.  As  this  excludes  the  pos- 
sibility of  contact,  pr  of  any  artificial  means  of  communication 
having  been  emffloyed,  it  niay  be  emphatically  styled  "  the  natural 
way"  of  getting  the  small-pox. t        '..-->  r-  j  t     ;    t...:,  j,     ;,...,  . 

2.  By  inhaling  air  impregnated  or  tainted  with  the  variolous  poi- 
son, which  is  diffused  through  it  in  a  state  of  the  minutest  possible 
division.  In  this  way,  the  matter  is  conveyed  to  the  pulmonary 
absorbents,  taken  up,  ^nd  carried  by  them  into  the  system,  which 
in  process  i>f  time  becomes  contaminated  and  poisoned.  By  this 
method  a  much  greater  quantity  of  virus  finds  its  way  into  the 
system— hence  the  greater  severity  of  the  disease  thus  induced. 
•In  this  case  the  matter  comes  in  contact  with  the  surface  of  the 
body,  and  also  with  that  of  the  mucous  membrane  of  the  bronchiae. 
The  former  (i.  e.  contact  with  the  surface)  constitutes,  as  we 
have  seen,  the  very  essence,  the  sine  qud  nan  of  contagion;  but  we 
have,  in  addition,  its  contact  with  the  pulmonary  tissues  which 
makes  "  assurance  doubly  sure;"  yet  if  it  is  not  absorbed  no  disease 


*  See  ElliotioR's  Practice,  by  Stewardson,  p.  444,  nnd  also  p.  309. 

t  It  is  impossible  to  furnish  a  stronger  proof  of  the  fact  that  infectious  diseases 
(a  certain  species  of  them  at  least)  do  afford  immunity  flroro  subsequent  attaclcs— 
or  In  other  words,  destroy  the  ■usceptibillty  of  the  system  to  the  impromion  ma«le 
by  that  particular  poison. 


It    'i 


APPENDIX. 


43 


is  conta- 
itagiouB, 
[)of  of  the 
the  habit 

ntagious  ? 
ct  or  indi- 
ponists,  a 
vhat  they 
rating  the 
questioA- 

utero,  and 
liseaae,  re- 
;mper.  In 
lal  aystem, 
69  the  po9- 
munication 
the  natural 

iriolous  poi- 
:eat  possible 
5  pulmonary 
stem,  which 
3d.    By  this 
iray  into  the 
tus  induced, 
jirface  of  the 
he  broncMae. 
tutes,  as  we 
gion ;  but  we 
issues  which 
ed  no  disease 

00. 

'ectious  diseases 
jquent  attacks — 
impression  made 


will  ensue,  as  would  have  happened  if  the  afTectioa  had  been  of  a 
contagious  nature.  Although  in  contact,  if  unabsorbed,  the  matter 
excites  no  morbid  action  whatever,  and  is  therefore  not  contagious. 

3.  By  breaking  the  cuticle  and  bringing  the  liquid  virus  in  cob- 
tact  with  the  cutaneous  absorbents,  which  take  it  up  and  convey  it ' 
into  the  system,  which  becomes  contaminated.  Communicated  in 
this  way,  the  disease  is  much  milder  than  when  communicated 
in  the  "second  mode,  because  less  matter  is  received  into  the  system 
— the  effect  of  a  poison  nr  of  a  medicine  being  in  the  common  sense 
way  of  reasoning  and  philosophizing  somewhat  in  proportion  to 
quantity  or  dose.     This  is  called  "  the  mode  by  inoculation." 

4.  Dr.  Gregory  tells  us  that  the  matter  of  the  pustules  or  scabs 
may  be  applied  to  the  unbroken  surface  of  the  skin  or  to  the  mucous 
membrane  of  the  nose,  and  be  absoVbed."  "  This,"  he  says,  •'  ij 
called  the  mode  by  contagion:"  "  but,"  continues  he,  ••  it  must  be 
admitted  that  the  terms  contagion  and  infection  are  often  use! 
indiscriminately  to  express  the  silent,  or  as  we  say  casual  reception 
of  the  germ."  Coming  as  it  does  from  the  pen  of  a  distinguished 
professor  and  author,  this  quotation  may  be  deemed  and  taken  as 
a  (air  specimen  of  professional  accuracy.  It  erhows  clearly  the 
difficulty  we  wish  to  get  rid  of.  Let  us  examine  Dr.  Gregory's 
"mode  by  contagion."  "The  matter  of  the  pustules  or  scabs," 
says  he,  "may  be  applied  to  the  unbroken  surface  of  the  skin." 
How  is  it  to  "  be  applied  to  the  unbroken  surface  of  the  skin," 
while  the  cuticle  remains  entire  ?*  If  the  cuticle  is  broken,  and  the 
matter  applied  to  the  unbroken  surface  of  the  skin,  it  amounts, 
de  faeto,  to  inoculation,  and  absorption  of  course  would  follow ; 
but  if  there  was  no  absorption,  then  there  would  be  no  disease,  as 
we  have  already  affirmed,  and  have  a  right  to  infer  from  Dr. 
Gregory's  own  statement;  but  if  it  had  been  the  matter  of  conta- 
gion the  specific  disease  would  have  ensued  without  absorption. 
"  Applied  to  the  mucous  membrane  of  the  nose,"  how,  we  would 

*  The  cntiele  is  mi  insensible  ^^unorganic  body,"  which  (accordint;  to  Cruvell- 
hier)  is  moulded  upon  the  "surface  uf  the  dermis  and  its  papillffi,  lilie  a  coat  of 
varnish,  and  protects  them  from  the  action  of  external  agents ;  and  we  add  ra^ro 
particulafly  of  such  "external  agenU"  as  are  capable  of  being  talcen  up  by  the 
cutaneous  absorbents.  It  ii'unnecessary  to  recount  the  experiments  wliich  have 
been  made  ftom  time  to  time,  in  reference  to  this  que»tion  of  cutaneous  abMirption. 


■,•-.  ■>' 


f 


44 


APPENDIX. 


'i    '^ 


aik,  could  it  be  so  applied,  and  the  effluvia  not  find  the  way  into 
the  lunga — bo  absorbed,  and  carried  into,  and  throughout  the  sys- 
tem ?  Again,  if  "  applied  to  the  unbroken  surface  of  the  skin,"  and 
kept  there  long  enough  to  infect  the  system,  through  the  unbroken 
cuticle,  would  it  nbt  1i!cewise  find  its  way  into  the  system  by  the 
p  'Imonary  absorbents  ? 

Suppose  the  leg  or  arm  of  an  individual,  or  indeed  the  whole 
body,  covered  with  the  scabs  or  the  liquid  virus,  or  exposed  to  an 
atmosphere  saturated  with  variolous  matter,  would  he  be  affected 
if  the  cuticle  remained  whole— the  head  being  excluded,  and  the 
air  he  breathed  *'  pure  as  the  breath  of  heaven,"  or  at  least  untaint- 
ed with  the  miasm  of  small-pox  ?  We  know  of  no  instance  on 
record  or  not  on  record,  in  which  the  disease  has  been  coifxiunicat- 
ed  under  such  circumstances,  and  we  do  not  believe  that  it  is 
communicable  by  contact*  so  long  as  the  respiratory  organs  are 
insulated,  and  the  cuticle  remains  unbroken.    :.(  \.s%  jahUpjkiii/.' 

We  shall  push  the  argument  no  further,  and  therefore  refrain  from 
examining  the  two  other  diseases  named.  Suffice  it  to  say,  that  like 
small-pox  they  are  infectious,  not  contagious :  that  they  tre  produceu 
by  the  absorption  of  a  specific  virus,  and  exhibit  symptoms  of  fever 
and  inflammation,  and  a  regular  series  of  phenomena ;  and  that  they 
afford  an  immunity  from  subsequent  attacks,  and  have  a  tendency 
io  a  spontaneous  cure — circumstances  which  separate  them  as  i^  an 
impassable  wall,  from  contagious  diseases.  Like  small-pox,  the  vac- 
cine disease  and  measles  furnish  perfect  examples  of  infectious 
maladies. 

If  they  are  infectious,  then  others  which  have  not  their  charac- 
teristic features,  or,  indeed,  a  single  symptom  in  common  with  them, 
cannot  by  any  rule  of  philosophizing  or  of  classification  with  which 
we  are  acquainted,  be  arranged  with  them,  and  called  infectious. 
If  so,  are  we  justified  in  pronouncing  cholera  an  infectious  disease  ?  ' 
Besides,  it  is  admitted  by  all,  that  cholera  may  and  does  break  out 
under  circumstances  which  preclude  the  possibility  of  its  having 
been  produced  by  the  absorption  of  a  specific  virus,  and  also  that  it 
terminates  in  a  manner  different  from  what  it  would  if  produced  by 
a  specific  poison ;  that  its  progress,  spread,  stay,  and  departure,  are 
all  unlike  vf  hat  might  be  expected  of  an  infectious  disease. 

If  cholera  is  not  produced  as  infectious  diseases  are, — ^ifitdoes  not 


T 


apAndix. 


45 


ray  into 
he  Bys- 
n,"  and 
nbroken 
by  the 

e  whole' 

id  to  an 

affected 

and  the 

untaint- 

itance  on 

x»unicat- 

that  it  is 

■jans  are 

rain  from 
,  that  like 
) produceu 
ts  of  fever 
^  that  they 
Bt  tendency 
masl^/an 
X,  the  vac- 
infectious 


exhibit  the  same  or  analogous  phenomena, — if  it  does  not  march  in 
the  same  train,  and  is  not  followed  by  the  same  results,  where  then 
is  the  propriety  of  arranging  it  with  them  as  of  the  same  nature  ?  If 
I  were  to  show  you,  kind  reader,  a  piece  of  metal,  and  tell  you  it 
was  a  specimen  of  the  California  gold,  would  you  take  it  to  be  gold 
if  the  yellow  color  and  other  attributes  of  that  metal  were 
absent?  ■■,.;.''      •  Z^-  -  : 

So,  if  I  were  to  show  you  a  disease,  and  tell  you  that  it  was  infec- 
tious, and  you  should  ask — was  it  caused  by  the  absorption  of  a  spe- 
cific virus  generated  in  a  living  body  ? — has  it  usually  exhibited 
symptoms  of  fever  and  inflammation  .'—does  it  afford  immunity  from 
subsequent  attacks?— has  it  a  tendency  to  a  spontaneous  cure  ? — 
does  it  originate  spontaoeously  ? — is  it  uniformly  or  generally  fol- 
lowed by  the  same  results  ?  No.  Then  I  trust  you  would  not  pro- 
nounce it  an  infectious  disease,  for  the  plain  and  simple  reason  that 
it  did  not  exhibit  the  phenoAena  or  possess  the  essential  attributes 
of  a  disease  of  that  character. 


.p^... 


'**i-i. 


air  charac- 
with  them, 
vith  which 
infectious, 
us  disease  ? 
1  break  ouk 
its  having 
also  that  it 
roduced  by 
)arture,  are 

96. 

fit  does  not 


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•  •■    .111     i    H    ■     «:.;•'••   .    .'''i,''*-    />*'-'.Vj.  I'V'ji  •'•: 


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■i"-- .   » 1 1 1 . 


THE    HORSE:     • 

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